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目的:探讨后腹腔镜下肾肿瘤手术困难改经腹腔途径可行性。方法:2013年1月~2014年1月采用腹腔镜经后腹腔途径对肾肿瘤(肿瘤直径4~8cm)患者行根治性肾切除过程中,因分离困难,肿瘤粘连周围脏器改经腹腔途径4例,观察手术时间、热缺血时间、术中出血量、围术期并发症及预后。结果:4例均顺利完成手术。平均手术时间75 min(65~90min),术中平均出血量120ml(80~200ml)。无迟发出血,平均住院7.5d(6~9d)。术后病理检查示肾透明细胞癌3例,乳头状肾细胞癌1例,切缘均为阴性。随访3个月肿瘤无复发。结论:经腹膜后途径腹腔镜根治性肾切除如遇操作困难,改经腹腔途径可避免开放手术,安全有效,并发症少,值得推广应用。
Objective: To investigate the feasibility of retroperitoneal laparoscopic radical nephrectomy with transabdominal approach. METHODS: From January 2013 to January 2014, laparoscopic transabdominal approach to renal neoplasm (tumor diameter 4 ~ 8cm) underwent radical nephrectomy. Due to the difficulty of separation, visceral organs around the tumor adhesion were changed into peritoneal cavity Four cases were observed operation time, warm ischemia time, intraoperative blood loss, perioperative complications and prognosis. Results: All 4 patients completed the operation smoothly. The average operation time was 75 min (65 ~ 90 min). The mean intraoperative blood loss was 120 ml (80-200 ml). No delayed bleeding, the average hospital 7.5d (6 ~ 9d). Postoperative pathological examination showed renal clear cell carcinoma in 3 cases, papillary renal cell carcinoma in 1 case, the margins were negative. Follow-up 3 months without tumor recurrence. Conclusions: Laparoscopic radical nephrectomy via retroperitoneal approach in case of difficult operation can be avoided by opening the abdominal cavity, which is safe and effective and has few complications. It is worth popularizing and applying.