肾周筋膜悬吊装置在后腹腔镜肾部分切除术中的应用

doi:10.19723/j.issn.1671-167X.2021.04.028

摘要/Abstract

摘要：

目的: 探讨肾周筋膜悬吊装置在后腹腔镜肾部分切除术中的应用效果,并分享手术经验。方法: 选取2018年10月至2020年12月期间6例具有肾脏腹侧肿物的病例,其中男、女各3例,左、右侧各3例,年龄38~60岁,平均52岁。体重指数18.3~30.2 kg/m²,平均22.9 kg/m²,1例合并糖尿病,3例合并肾囊肿,2例既往胆囊切除术后,均为体检发现,病程7 d至20年(中位时间1个月)。肿物位置均为患侧肾脏腹侧,2例位于肾上极,1例位于肾下极,3例位于肾门附近。肿瘤大小1.2~7.8 cm,平均4.5 cm。R.E.N.A.L评分1例7分,3例8分,2例9分。完善检查后行后腹腔镜肾部分切除术(肾周筋膜悬吊装置法)。结果: 所有手术均顺利完成。手术时间139~193 min,平均172 min,肾动脉阻断时间7~43 min,平均19 min,有1例阻断时间超过30 min。出血10~500 mL,平均128 mL。术后住院时间4~13 d,平均6.5 d。术后病理回报4例为肾血管平滑肌脂肪瘤,2例为肾透明细胞癌。随访2~27个月,平均17个月,随访期间无复发。结论: 在后腹腔镜肾部分切除术中悬吊肾周筋膜有利于暴露腹侧术野,同时便于术者双手操作,是处理肾脏腹侧肿瘤的有效方法。

关键词: 后腹腔, 腹腔镜, 肾部分切除, 悬吊技术

Abstract:

Objective: To evaluate the value of Gerota’s fascia suspension device in retroperitoneal laparoscopic partial nephrectomy, and to share the operation experience. Methods: From October 2018 to December 2020, 6 cases of tumor located in the ventral side of the kidney were selected, including 3 males and 3 females, with 3 cases on the right side and 3 cases on the left side, aged 38-60 years, with an average of 52 years. The body mass index (BMI) was 18.3-30.2 kg/m², with an average of 22.9 kg/m². One patient with diabetes mellitus, three patients with renal cysts, and two patients underwent cholecystectomy before. All the patients were found by physical examinations. The course of disease was 7 days to 20 years, with a median time of 1 month. The tumor was in the ventral side of the kidney, 2 cases located in the upper pole, 1 case in the lower pole and 3 cases near the renal hilum. The tumor size was 1.2-7.8 cm, with an average of 4.5 cm. The R.E.N.A.L score was 7 in 1 case, 8 in 3 cases and 9 in 2 cases. After the preoperative examination completed, retroperitoneal laparoscopic partial nephrectomy (Gerota’s fascia suspension device) was performed. Results: All the operations were successfully completed. The operation time ranged from 139 to 193 min,with an average of 172 min. The renal artery occlusion time was 7-43 min, with an average of 19 min, only one case was more than 30 min. The blood loss ranged from 10 to 500 mL, with an average of 128 mL. The postoperative hospital stay ranged from 4 to 13 days, with an average of 6.5 days. Postoperative pathology revealed 4 cases of renal angiomyolipoma and 2 cases of renal clear cell carcinoma. The patients were followed up for 2-27 months, with an average of 17 months, without recurrence. Conclusion: In the operation of retroperitoneal laparoscopic partial nephrectomy, Gerota’s fascia suspension device is beneficial to expose the ventral surgical field, and it is convenient for the surgeon to operate with both hands. This technique is an effective method to deal with the ventral renal tumor, which is worthy of promotion.

Key words: Retroperitoneal, Laparoscope, Partial nephrectomy, Suspension technique

中图分类号:

R692.6

邱敏,王璐,邓绍晖,拓鹏飞,郭巍,卢剑,刘承,马潞林. 肾周筋膜悬吊装置在后腹腔镜肾部分切除术中的应用[J]. 北京大学学报（医学版）, 2021, 53(4): 789-792.

QIU Min,WANG Lu,DENG Shao-hui,TA Peng-fei,GUO Wei,LU Jian,LIU Cheng,MA Lu-lin. Primary application of Gerota’s fascia suspension device in retroperitoneal laparoscopic partial nephrectomy[J]. Journal of Peking University (Health Sciences), 2021, 53(4): 789-792.

图/表 1

图1

参考文献 10

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