First Department of Urology, University of Athens Medical School, Laiko General Hospital, Ag. Thoma 17, Goudi, 115 27 Athens, Greece.
Anticancer Res. 2012 Nov;32(11):5023-9.
Several surgical approaches have been used for radical nephrectomy for large and locally advanced tumors of the right kidney.
To present our experience with radical nephrectomy using a right subcostal incision with a transperitoneal approach in patients with very large tumors of the right kidney.
Between 2003 and 2010, 34 patients with very large tumors of the right kidney were submitted to surgery. Eighteen patients underwent a transperitoneal approach with a right subcostal incision (intervention group) and 16 patients were operated on with retroperitoneal flank incision (control group).
No significant complications during surgery were observed in the intervention group; two patients needed blood transfusions of 300 cc during the first postoperative day. In the control group, injury of the renal vein or inferior vena cava (IVC) was a relatively common complication; five patients needed blood transfusions of 300 cc during the first postoperative day.
A transperitoneal right subcostal incision for radical nephrectomy in patients with large and locally advanced tumors of the right kidney seems to offer better access to the renal pedicle, and to the great vessels of the area as well as better exposure of the organs of the abdominal cavity. This approach could be more useful in cases in which liver involvement is possible.
对于右肾的大肿瘤和局部晚期肿瘤，已经采用了几种手术方法进行根治性肾切除术。
介绍我们在右肾大肿瘤患者中采用经腹腔右肋缘下切口根治性肾切除术的经验。
2003 年至 2010 年期间，34 例右肾大肿瘤患者接受了手术治疗。18 例患者接受了经腹腔右肋缘下切口（干预组），16 例患者接受了经腹膜后侧腰部切口（对照组）。
干预组术中无明显并发症；2 例患者术后第 1 天需要输血 300cc。对照组中，肾静脉或下腔静脉（IVC）损伤是一种相对常见的并发症；5 例患者术后第 1 天需要输血 300cc。
对于右肾大肿瘤和局部晚期肿瘤患者，经腹腔右肋缘下切口根治性肾切除术似乎可以更好地接近肾蒂以及该区域的大血管，并更好地暴露腹腔器官。对于可能涉及肝脏的病例，这种方法可能更有用。
