Khoder W Y, Stief C G, Becker A J
Urologische Klinik und Poliklinik, Klinikum Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.
Urologe A. 2009 Dec;48(12):1523-34. doi: 10.1007/s00120-009-2118-x.
Laparoscopy has been progressively gaining acceptance in the urologic arena. The start with renal surgery was slow; however, after complete establishment for benign indications the breakthrough occurred due to the success of laparoscopy in the field of oncologic surgery. Laparoscopic radical nephrectomy for stage T1 and T2 tumours, whether transperitoneal or retroperitoneal, can be performed safely. The surgical steps duplicate the open procedure. The overall complication rate is low and does not significantly differ from that of the open procedure. Laparoscopic partial nephrectomy is, in contrast, a technically challenging procedure despite its realisation laparoscopically. Although the intermediate outcomes are comparable to those of the open procedure, there are concerns related to warm ischemia time and the risk of major complications such as urinary leakage and haemorrhage requiring transfusion, so that it should be performed only in centres with expertise.
腹腔镜检查在泌尿外科领域已逐渐得到认可。其在肾脏手术方面的起步较为缓慢;然而,在良性适应症方面完全确立之后,由于腹腔镜检查在肿瘤外科领域的成功,取得了突破。对于T1和T2期肿瘤,无论是经腹还是腹膜后腹腔镜根治性肾切除术都可以安全进行。手术步骤与开放手术相同。总体并发症发生率较低,与开放手术相比无显著差异。相比之下,腹腔镜部分肾切除术尽管是通过腹腔镜完成的,但在技术上具有挑战性。虽然中期结果与开放手术相当,但存在与热缺血时间以及诸如尿漏和需要输血的出血等主要并发症风险相关的担忧,因此该手术应仅在具备专业技术的中心进行。