Kerbl K, Clayman R V, McDougall E M, Kavoussi L R
Department of Surgery (Division of Urology), Washington University School of Medicine, St Louis, MO 63110.
BMJ. 1993 Dec 4;307(6917):1488-9. doi: 10.1136/bmj.307.6917.1488.
Since the first clinical operation in June 1990 laparoscopic nephrectomy for benign renal disease has become widely accepted. Although the laparoscopic operation takes much longer than open surgery, there are considerable reductions in the length of postoperative hospital stay and the time taken to return to normal activities and to full recovery. Major complications were relatively common in early operations, but with more experience morbidity has been reduced. Laparoscopic nephrectomy for malignant renal disease is still controversial, largely because of the fear of release of malignant tissue into the abdominal cavity during the morcellation and retrieval of the diseased kidney. To prevent this, the kidney is removed intact through a 5-7 cm incision. Long term follow up is needed, however, before we will know whether the laparoscopic procedure is effective in preventing recurrence of cancer. New developments have improved various technical aspects of the operation, but stringent assessment of new techniques is necessary so that the medical community can decide which procedures should become routine practice.
自1990年6月首次开展临床手术以来，腹腔镜肾切除术治疗良性肾脏疾病已被广泛接受。尽管腹腔镜手术比开放手术耗时长得多，但术后住院时间以及恢复正常活动和完全康复所需的时间都大幅缩短。早期手术中主要并发症相对常见，但随着经验增多，发病率已有所降低。腹腔镜肾切除术治疗恶性肾脏疾病仍存在争议，主要是因为担心在切碎和取出患病肾脏的过程中恶性组织释放到腹腔。为防止这种情况，通过一个5 - 7厘米的切口完整切除肾脏。然而，在我们知道腹腔镜手术是否能有效预防癌症复发之前，需要长期随访。新的进展改善了手术的各个技术环节，但对新技术进行严格评估是必要的，以便医学界能够决定哪些手术应成为常规做法。
