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目的比较经腹腹腔镜肾癌根治术中不同的肾动脉阻断技术,评价超早期肾动脉阻断技术的安全性及可行性。方法 2008年5月至2010年12月间,由我院泌尿外科同一手术组共完成64例T1N0M0～T2N0M0期经腹腹腔镜肾癌根治术,其中按标准方式分离并阻断肾动脉者33例(A组),经Treitz韧带(左侧)或经主动脉-下腔静脉间隙(右侧)超早期阻断肾动脉者31例(B组),两组患者间临床基本参数(年龄、性别构成、体质指数、既往腹部手术史、肿瘤侧别、肿瘤最大径、术前TNM分期等)的差异无统计学意义。结果 A组1例患者因肾周广泛粘连,分离过程中因出血较多转开放,其余患者均成功实施经腹腹腔镜肾癌根治手术。两组患者间手术时间、术中出血量、术中及术后并发症、术后TNM分期、术后禁食时间、术后引流管留置时间、术后住院时间、病理类型等差异均无统计学意义,但B组T2期患者术中出血量少于A组(P<0.05)。结论经腹腹腔镜肾癌根治术中采用超早期肾动脉阻断技术是安全可行的,既遵循了无瘤原则又能减少T2期肾癌术中出血,且在一定程度上拓宽了肾癌腹腔镜手术的适应证。
Objective To compare the different renal artery occlusion techniques in radical laparoscopic radical nephrectomy and evaluate the safety and feasibility of ultra-early renal artery occlusion. Methods From May 2008 to December 2010, 64 cases of T1N0M0 ~ T2N0M0 transabdominal laparoscopic radical nephrectomy were performed in the same surgery group of urology department of our hospital. 33 cases of renal artery were isolated and blocked according to standard methods (Group A), 31 patients (group B) who had ultra-early blockage of the renal artery through the Treitz ligament (left) or the aorto-inferior vena cava gap (right), and the basic clinical parameters Constitution, body mass index, previous history of abdominal surgery, tumor side, tumor maximum diameter, preoperative TNM stage, etc.) was not statistically different. Results A group of patients with extensive peritoneal adhesions, bleeding during the separation more turn to open the rest of the patients were successfully implemented radical laparoscopic radical nephrectomy. There was no statistical difference between the two groups in the operation time, intraoperative blood loss, intraoperative and postoperative complications, postoperative TNM stage, postoperative fasting time, postoperative drainage tube indwelling time, postoperative hospital stay, pathological type However, the amount of bleeding in group B was less than that in group A (P <0.05). Conclusion Transabdominal laparoscopic radical nephrectomy with ultra-early renal artery occlusion is safe and feasible, which not only follows the principle of tumor-free but also reduces intraoperative bleeding during T2-stage renal cell carcinoma and broadens the peritoneal cavity of renal cell carcinoma to a certain extent Mirror surgery indications.