论文部分内容阅读
目的:探索基于肾单位精细解剖的后腹腔镜保留肾单位肾部分切除的手术方法和技巧,借助解剖方法减少出血和尿瘘的可能性。方法:我院2012年1～12月期间住院的肾脏肿瘤患者31例,男19例,女12例,年龄28～68岁,平均(56.1±13.8)岁。肿瘤直径1.2～6.0cm,平均(3.4±0.7)cm。术中阻断肾动脉后,距肿瘤边缘3～5mm剪开肾包膜及肾皮质,在肾实质的切口内,沿肾锥体髓放线钝性加锐性向深处和基底分离,使包裹一层肾髓质的瘤体与保留的肾脏髓质分开,显露出的基底部的血管应用双极电凝后剪断。仔细剥离肾小盏,以可吸收线两层缝合,关闭肾脏创面。记录动脉阻断时间、手术时间、术中出血量、术后引流量、病理结果和手术并发症。结果:本组31例患者采用切开包膜实质剥离髓质方法均获成功。其中19例可见基底部1支血管,8例可见2支血管,19例可见肾盏。平均手术时间(95.5±27.1)min;平均术中动脉阻断时间(21.2±7.2)min;平均术中出血量(55.7±18.9)ml;平均术后引流量(92.3±28.9)ml,平均术后住院时间(6.1±0.6)d;术后无继发出血、漏尿等并发症发生。所有标本呈完整楔形块状,切缘均为阴性。术后病理证实:肾透明细胞癌27例、嗜酸细胞腺瘤1例、肾小球旁细胞瘤1例、嫌色细胞癌2例。TNM分期:T1a期28例,T1b期3例。结论:采用切开包膜和实质剥离肾髓质改良的后腹腔镜保留肾单位肾部分切除术,切除瘤体部所附着肾组织确切完整,有利于切缘阴性。基底部止血确实,处理累及的肾盏确切,可以减少术后继发出血及漏尿的发生。
OBJECTIVE: To explore the surgical methods and techniques of retroperitoneal laparoscopic nephron excision based on the fine anatomy of nephron, and to reduce the possibility of hemorrhage and urinary fistula by means of anatomy. Methods: There were 31 hospitalized patients with renal tumors from January 2012 to December 2012 in our hospital. There were 19 males and 12 females, ranging in age from 28 to 68 years (mean, 56.1 ± 13.8) years. Tumor diameter 1.2 ~ 6.0cm, with an average (3.4 ± 0.7) cm. Intraoperative renal artery occlusion, from the edge of the tumor 3 ~ 5mm cut renal capsule and renal cortex, in the renal parenchyma incision, along the renal cone retraction of the cord and blunt dissection to the depth of the base separation, so wrapped A layer of renal medullary tumor separated from the retained renal medulla, showing the base of the blood vessels after bipolar coagulation. Carefully peel off the small calyx to absorb the two suture lines, close the kidney wound. Arterial occlusion time, operation time, intraoperative blood loss, postoperative drainage, pathological findings and surgical complications were recorded. Results: All the 31 patients in our group were successful in incising the medulla by means of incision capsule. Among them, 19 cases showed one branch of blood vessels in base, two vessels were seen in 8 cases and renal calyx was seen in 19 cases. The average operation time was (95.5 ± 27.1) min, the average time of intraoperative arterial occlusion was (21.2 ± 7.2) min, the average blood loss was (55.7 ± 18.9) ml, the mean postoperative drainage was 92.3 ± 28.9 ml, After hospital stay (6.1 ± 0.6) d; no postoperative bleeding, leakage of urine and other complications occurred. All samples showed a complete wedge-shaped, cut edge were negative. Postoperative pathology confirmed: 27 cases of clear cell renal cell carcinoma, 1 case of eosinophilic adenoma, 1 case of glomerular para-tumor and 2 cases of chromophobe carcinoma. TNM staging: T1a 28 cases, T1b 3 cases. CONCLUSION: Retroperitoneal laparoscopic nephrectomy with incised enamel and stripped renal medulla modified the nephron partial nephrectomy. The excision of the nephridial tissue attached to the tumor is complete and complete, which is good for negative margins. Basal hemostasis Indeed, the treatment of implicated calyx is exact, can reduce postoperative secondary bleeding and leakage of urine.