后腹膜腹腔镜肾癌根治性手术安全性临床探究.docVIP

后腹膜腹腔镜肾癌根治性手术安全性临床探究 　 作者：杨政兴，卢洪凯，刘鲁东，臧运江，王沈阳，张明荣 【摘要】 目的：探讨后腹膜腹腔镜肾癌根治术临床应用的安全性。方法：行后腹腔镜肾癌根治术２７例，经腹腹腔镜行肾癌根治术２４例，比较两种方法肠管及大血管的损伤、手术时间、出血量、住院时间、ＣＯ２对机体的影响（血气分析：PaCO２、pH）、肠道恢复时间、肠粘连、术后肩痛、切口种植转移的差别。结果：后腹腔镜手术时间为（１８０±３０）min,出血８０～３００ml，平均１２０ml,均未输血，平均住院７d；切口种植转移１例，术后肩痛１例，肠道恢复时间（２４±４）h，血气分析pH（7.35±0.11）、PaCO２ （42.45±6.15）mm Hg;经腹腹腔镜３例穿刺损伤肠管、２例损伤腹部血管，手术时间（２００±４０）min，出血１００～３００ml，平均２００ml，均未输血，血气分析pH （7.40±0.10）、PaCO2 （43.45±6.45）mm Hg；平均住院１０d，术后肩痛８例，肠道恢复时间（３８±６）h，２例发生肠梗阻。结论：后腹腔镜肾癌根治术同经腹腹腔镜肾癌根治术相比，出血少，康复快，血管及肠管的损伤、肠道功能恢复、术后肩痛均有显著性差异（Ｐ＜００５）；血气分析，切口种植转移无显著性差异（Ｐ＞００５）。手术效果相当。 　　【关键词】 肾肿瘤；后腹膜腹腔镜；肾切除术；腹腔镜 　　Clinical study the safety of the retroperitoneal laparoscopic radical nephrectomy 　　【Abstract】 Ｏbjective:To summary the experience of retroperitoneal laparoscopic radical nephrectomy and transperitoneal laparoscopic radical nephrectomy.Methods:Twentyseven retroperitoneal laparoscopic radical nephrectomy and twentyfive transperitoneal laparoscopic radical nephrectomy were performed,operation time,blood loss,risks related to trocar insertion,CO2 absorption,postoperative ileus,shoulder pain,length of stay and effect of operation of them were comparatively studied.Results:All cases were performed successfully.There was no case converting to open surgery.In retroperitoneal laparoscopic radical nephrectomy the operative time was(180±30)min,the average blood loss was 120ml and the time of recovery of bowel function was (24±4)h.In transperitoneal laparoscopic radical nephrectomy the operative time was (200±40)min.The average blood loss was 200ml and the time of recovery of the bowel function was (38±6)h.Conclusions:Retroperitoneal laparoscopic radical nephrectomy was superior to transperitoneal laparoscopic radical nephrectomy,It has the merits of less blood loss,less shouder and neck pain and faster recovery of the bowel function. 　　【Key words】 Kidney neoplasms;Retroperitoneal laparoscopic;Nephrectomy;Laparoscopy 1９９２年Gaur［1］首创球囊扩张成功分离后腹膜，使后腹膜途径成为可能。２００３年１月至２００５年２月我院先后采用经腹及后腹腔镜的方式治疗肾癌，