| 摘要: |
| 目的 探讨腰腹联合三步法腹腔镜肾部分切除术临床应用的安全性和有效性。 方法 回顾分析2015年7月至11月期间,32例接受腹腔镜肾部分切除术患者的临床资料。其中接受腰腹联合三步法术式的患者12例(三步法组),接受传统经腹术式患者20例(对照组)。三步法组手术方法:(1)首先经腹入路,切开腹侧Gerota筋膜和肾周脂肪至肾实质表面,并显露肿瘤;(2)沿结肠旁沟Told线切开腹膜和肾周筋膜,由肾脏背侧,贴腰大肌平面分离肾动脉;(3)阻断肾动脉,标记肿瘤边缘,完成肾脏肿瘤的切除和创面重建。比较两组围手术期资料。 结果 32例手术均顺利完成,腰腹联合三步法相比传统经腹腔途径可有效缩短手术时间(P=0.014),术中出血等围手术期资料与传统方法类似。 结论 腰腹联合三步法改良后的腹腔镜肾部分切除术既保留了经腹途径操作空间大的优点,又结合了经腰途径分离肾动脉便捷的长处,尤其肾动脉出现变异时,优势更加明显,可进行深入的临床对比研究。 |
| 关键词: 肾肿瘤 保留肾单位手术 腰腹联合三步法入路 经腹入路 |
| DOI：10.16781/j.0258-879x.2016.01.0083 |
| 投稿时间：2015-11-23修订日期：2015-12-31 |
| 基金项目: |
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| Laparoscopic partial nephrectomy via combined “trans-retro-peritoneal three-step” approach: an initial experience |
| YANG Bo△,GAO Xiao-feng△,WANG Hui-qing,ZHANG Chao,LI Ling,PENG Yong-han,GUO Fei,SUN Ying-hao* |
(Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
△Co-first authors.
*Corresponding author.) |
| Abstract: |
| Objective To evaluate the safety and efficacy of laparoscopic partial nephrectomy via a combined "trans-retro-peritoneal three-step" approach. Methods The clinical data of 32 patients who received laparoscopic partial nephrectomy between Jul. 2015 and Nov. 2015 were retrospectively analyzed. Twenty cases were via the traditional transperitoneal approach and the other 12 cases via a novel combined "trans-retro-peritoneal three-step" approach. The 3 steps in this novel approach included: (1) Through transperitoneal approach, Gerota's fascia and perirenal fat were incised to expose the tumor; (2) The peritoneum and Gerota's fascia were incised along the Told's line, and the renal artery was then separated on the surface of the psoas muscle; and (3) The renal artery was clamped, the edge of the tumor was marked, and finally the tumor was resected and the kidney was reconstructed. The perioperative data of the two groups were compared. Results The surgeries were successfully performed in all the 32 patients. Compared to traditional transperitoneal approach, our novel approach significantly shortened the operation time (P=0.014). The other perioperative parameters, such as estimated blood loss, were comparable in the two groups. Conclusion This combined "trans-retro-peritoneal three-step" approach has the combined the advantage of traditional transperitoneal (enough room for manipulation) and retroperitoneal (convenience to separate the renal arteries) approaches, especially when the renal artery is abnormal. Further studies are needed to compare the present approach with the traditional surgeries. |
| Key words: kidney neoplasms nephron sparing surgery "trans-retro-peritoneal three-step" approach transperitoneal approach |
