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目的 介绍简易手助腹腔镜下肾及肾上腺肿瘤切除术的方法和特点。 方法 1999年 6月至 2 0 0 4年 4月采用简易手助装置实施手助腹腔镜下肾及肾上腺肿瘤切除术 ,共 37例。男 2 2例 ,女 15例 ,平均年龄 5 2岁。肾切除组 2 9例 ,其中肾癌 13例 ,肾盂癌 2例 ,肿瘤分期均为T1N0 M0 ,肿瘤大小平均 3cm× 3cm× 2cm ,巨大肾积水 (肾无功能 ) 8例 ,肾结核肾自截 2例 ,肾性高血压肾萎缩 4例 ;肾上腺肿瘤切除组 8例 ,肿瘤大小平均 4cm× 5cm× 6cm。 结果 除 1例肾癌患者改行开放手术外 ,36例患者手术成功 ,无损伤肠管及其他腹内重要脏器等并发症。肾切除术平均手术时间 14 5min ,平均出血量 115ml;肾上腺肿瘤切除术平均 12 5min ,平均出血量 10 5ml。术后恢复好 ,7～ 8d出院。术后随访 3个月～ 5年 ,健康存活 35例 ;死亡 2例 ,均为肾癌患者 ,其中 1例术后 2年死于脑血管意外 ,1例术后 3年死于肺及脑部转移。 结论 简易手助腹腔镜下肾及肾上腺肿瘤切除术具有简便易行、节省费用、手术时间短、术后恢复快等优点 ,值得推广。
Objective To introduce the methods and features of simple hand-assisted laparoscopic radical nephrectomy and adrenal tumor resection. Methods From June 1999 to April 2004, hand-assisted laparoscopic radical nephroureterectomy and adrenalectomy were performed in 37 patients. There were 22 males and 15 females, with an average age of 52 years. Nephrectomy group 29 cases, including 13 cases of renal cell carcinoma, renal pelvis cancer in 2 cases, the tumor stage were T1N0 M0, the average tumor size of 3cm × 3cm × 2cm, 8 cases of giant hydronephrosis (renal nonfunction), renal tuberculosis kidney 2 cases were cut off, 4 cases were renal atrophy of renal hypertension, 8 cases were treated by adrenal tumor resection, the average tumor size was 4cm × 5cm × 6cm. Results In addition to the one case of renal cell carcinoma patients underwent open surgery, 36 cases of successful surgery, no damage to the intestine and other intra-abdominal organs and other complications. The average operation time of nephrectomy was 14 5min, the average amount of bleeding was 115ml. The average adrenal tumor resection was 12 5min and the average amount of bleeding was 10 5ml. Postoperative recovery, 7 ~ 8d discharge. The patients were followed up for 3 months to 5 years and 35 healthy survivors. Two patients died of renal cell carcinoma, of which 1 died of cerebrovascular accident 2 years after operation and 1 died of lung and brain 3 years after operation Transfer. Conclusions Simple hand-assisted laparoscopic radical nephrectomy and adrenal tumor resection are easy to operate, cost saving, short operative time and rapid postoperative recovery, which are worthy of popularization.