Gill I S
Section of Laparoscopic and Minimally Invasive Surgery, Cleveland Clinic Foundation, Ohio, USA.
Urol Clin North Am. 2000 Nov;27(4):707-19. doi: 10.1016/s0094-0143(05)70120-8.
Laparoscopic radical nephrectomy is a rapidly emerging technique for the treatment of renal cell carcinoma. Surgeons at multiple institutions have reported excellent technical results with this procedure, with encouraging safety and efficacy data and low complication rates comparable with the rates in open radical nephrectomy. Although debate continues regarding the pros and cons of the transperitoneal versus retroperitoneal approach and regarding morcellation versus intact specimen extraction, laparoscopic radical nephrectomy is beginning to approach standard-of-care status at select institutions for tumors less than 8 cm in size. Although generally accepted indications for laparoscopic radical nephrectomy include T1-T2N0M0 tumors, increasing experience and operator confidence have allowed expansion of these indications to include select patients with nodal disease, preoperatively staged level I renal vein thrombus, cytoreductive surgery before immunotherapy protocols, and the rare patient with a laterally directed locally invasive (pT4N0M0) renal cell carcinoma.
腹腔镜根治性肾切除术是一种迅速兴起的治疗肾细胞癌的技术。多家机构的外科医生报告了该手术出色的技术成果，其安全性和有效性数据令人鼓舞，并发症发生率低，与开放性根治性肾切除术相当。尽管对于经腹腔途径与经腹膜后途径的利弊以及碎块切除与完整标本取出仍存在争议，但在一些机构中，对于直径小于8 cm的肿瘤，腹腔镜根治性肾切除术已开始接近标准治疗地位。虽然腹腔镜根治性肾切除术通常公认的适应证包括T1-T2N0M0肿瘤，但随着经验的增加和术者信心的增强，这些适应证已扩大到包括部分有淋巴结疾病的患者、术前分期为I级肾静脉血栓的患者、免疫治疗方案前的减瘤手术患者以及罕见的侧向局部浸润性（pT4N0M0）肾细胞癌患者。
