[1]马潞林,黄毅,田晓军,等.后腹腔镜根治性肾癌切除术的解剖标志[J].中国微创外科杂志,2005,05(3):216-218.
　Ma Lulin,Huang Yi,Tian Xiaojun,et al.Anatomic landmarks during retroperitoneoscopic radical nephrectomy[J].Chinese Journal of Minimally Invasive Surgery,2005,05(3):216-218.
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后腹腔镜根治性肾癌切除术的解剖标志()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
05
期数:
2005年3期
页码:
216-218
栏目:
出版日期:
2005-03-31

文章信息/Info

Title:
Anatomic landmarks during retroperitoneoscopic radical nephrectomy
作者:
马潞林; 黄毅; 田晓军; 侯小飞; 赵磊; 卢剑; 洪锴
北京大学第三医院泌尿外科,北京,100083
Author(s):
Ma Lulin;  Huang Yi;  Tian Xiaojun;  et al.
Department of Urology, Peking University Third Hospital, Beijing 100083, China
关键词:
腹腔镜;  肾切除;  解剖;  肾癌
Keywords:
Laparoscopy; 　Nephrectomy; 　Anatomy; 　Renal carcinoma
分类号:
R737.11
文献标志码:
A
摘要:
目的探讨经后腹腔途径行肾癌根治术的解剖标志. 方法 2002年11月～2004年7月,后腹腔镜下行肾癌根治术46例.第1个trocar位置在第12肋下缘2 cm骶棘肌外侧交界处,第2个trocar位置在髂嵴上缘中点,或髂前上嵴内上方2 cm左右,第3个trocar在腋前线与肋弓下2 cm交界处.首先寻找腰大肌为背侧标志,膈肌为肾上极后侧标志,肾上腺为肾上方内侧标志,腹膜为腹侧标志.肾静脉位于肾动脉前下方.分离右肾静脉应常规分至下腔静脉汇合处.直线切割器分别切除肾动、静脉. 结果手术时间平均145 min(60～255 min),术中出血量平均133 ml(20～1 000 ml).肾上腺切除32例,占69.6%(32/46).1例由于解剖标志不清出血改为开放手术;1例直线切割器切右肾静脉时,误将腔静脉切割封闭了1/2;腹膜损伤4例.46例随访1～20个月,平均9个月.1例因肾癌肝转移,术后1年死亡,余45例无瘤生存. 结论良好的解剖标志是后腹腔镜下肾癌根治术成功的关键.
Abstract:
Objective　To discuss anatomic landmarks during retroperitoneoscopic radical nephrectomy.　M ethods　A total of46 patients underwent retroperitoneoscopic radicalnephrectomies from November2002 to July 2004.The first trocarwas introduced at the union of the site 2 cm below the 12 th costalmarginwith the lateral side of themusculus sacrospinalis.The second trocarwas placed at themidpoint of the upper border of the iliac crest, or at the location above and medial to the anterior superior iliac spine.And the third onewas inserted at the union of the anterior axillary line with the costalmargin. In the first place, the greater psoasmuscle was identified as the dorsalmarker.Then the diaphragmaticmusclewas identified as the posteriormarker of the upper pole of the kidney, and the adrenal gland as themedialmarkerof the upperpole of the kidney, and the peritoneum as the ventralmarker.The renalvein lay below and anterior to the renal artery.The right renalveinwas routinely sperated rightup to the joining sitewith the inferiorvena cava. A linear cutterwas used to resect the renal vein and artery respectively.　Results　The mean operation time was 145 min ( range, 60~255 min) and the mean intraoperative blood loss was 133 ml ( range, 20~1 000 ml). Adrenalectomy was performed in 32 patients (69·6% ). A conversion to open surgerywas required in 1 patient because anatomic landmarks could not be well seen. The inferior vena cavawaswrongly closed off by 1/2 cross-section when using a linear cutter to sever the right renal vein in 1 patient. Peritoneal injuries happened in 4 patients.Follow-up was carried out for1~20 months (mean, 9 months) in all the 46 patients.One patientdied of livermetastasis 1 year after the surgery, while the remaining 45 patients survived without recurrence.　Conclusions　 Proper identification of anatomic landmarks is crucial to a successful retroperitoneoscopic nephrectomy.

参考文献/References:

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更新日期/Last Update: 2014-03-11