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目的:探讨后腹腔镜技术联合肋缘下切口处理巨大肾肿瘤伴肾静脉癌栓的可行性及安全性研究。方法:对24例巨大肾肿瘤伴肾静脉癌栓患者均采用在后腹腔镜的方式结扎并切断肾动脉,再取患侧肋缘下切口,切除癌栓及肾脏的方法进行治疗,观察患者术中及术后各项临床指标,术后随访患者复发情况。结果:本组平均手术时间105(95~165)min,术中出血量平均130(100~190)ml,术后平均排气时间8(6~12)h,平均住院时间10(8~12)d。术后随访24例,平均随访时间13(7~20)个月。7例分别于术后5、6、8、10、13、14、17个月时复发,转移至肺、肝及后腹膜等部位而死亡,其余未见肿瘤复发及转移等。结论:后腹腔镜技术联合肋缘下切口是治疗巨大肾肿瘤伴肾静脉癌栓安全有效的方法之一。
Objective: To investigate the feasibility and safety of retroperitoneal laparoscopic surgery combined with inferior incision in the treatment of giant renal tumor with renal vein tumor thrombus. Methods: Twenty-four cases of giant renal tumor with renal vein thrombosis were treated by retroperitoneoscopic laparoscopic ligation and resection of the renal artery, then under the incision of the marginal costal margin, resection of tumor thrombus and the kidneys. The patients underwent surgery During and after the clinical indicators, postoperative follow-up of patients with recurrence. Results The mean operative time was 105 (95-165) min, the average amount of intraoperative bleeding was 130 (100-190) ml, the average postoperative exhaust time was 8 (6-12) h, the average length of stay was 10 (8-12 d. Twenty-four patients were followed up for an average of 13 (7-20) months. 7 cases were relapsed at 5, 6, 8, 10, 13, 14 and 17 months after operation, respectively, and then they were lost to lung, liver and retroperitoneum. No other tumor recurrence and metastasis were observed. Conclusions: Retroperitoneal laparoscopic technique combined with subcuticular incision is one of the safe and effective methods for the treatment of giant renal tumor with renal vein tumor thrombus.