Gasman D, Saint F, Barthelemy Y, Antiphon P, Chopin D, Abbou C C
Service d'Urologie, Hôpital Henri Mondor, Créteil, France.
Urology. 1996 Jun;47(6):801-6. doi: 10.1016/S0090-4295(96)00064-7.
Retroperitoneoscopy has gained acceptance for urologic surgery. We assessed the safety and efficacy of this procedure for renal and adrenal surgery.
Since December 1994, 20 patients (18 to 75 years old) have undergone laparoscopic adrenalectomy and nephrectomy, including simple nephrectomy in 8, partial nephrectomy in 1, radical nephrectomy in 2, tumorectomy with cyst excision in 1, and adrenalectomy in 8. The retroperitoneal space was created by blunt dissection with the index finger, completed by insufflation, without balloon dissection.
Average kidney size was 65 m (range 50 to 108), and average adrenal tumor size was 31 mm (range 20 to 40). The average operating time was 127 minutes (range 60 to 180) for nephrectomy and 84 minutes (range 45 to 140) for adrenalectomy. The average hospital stay was 3 days (range 1 to 7) for nephrectomy and 2.4 days (range 1 to 4) for adrenalectomy. Average blood loss was 65 mL for both nephrectomy and adrenalectomy. Conversion from the laparoscopic procedure to open surgery was never required. Peritoneal effraction and ureteral injury occurred in only 4 patients and 1 patient, respectively.
The laparoscopic retroperitoneal approach is safe and effective for simple renal nephrectomy and for excision of small adrenal tumors. Perioperative morbidity and hospital stay are reduced.
后腹腔镜手术已被泌尿外科手术所接受。我们评估了该手术在肾脏和肾上腺手术中的安全性和有效性。
自1994年12月以来，20例患者（年龄18至75岁）接受了腹腔镜肾上腺切除术和肾切除术，其中包括单纯肾切除术8例、部分肾切除术1例、根治性肾切除术2例、肿瘤切除加囊肿切除术1例、肾上腺切除术8例。通过食指钝性分离建立后腹膜间隙，经充气完成，未使用球囊分离。
平均肾脏大小为65 m（范围50至108），平均肾上腺肿瘤大小为31 mm（范围20至40）。肾切除术平均手术时间为127分钟（范围60至180），肾上腺切除术平均手术时间为84分钟（范围45至140）。肾切除术平均住院时间为3天（范围1至7），肾上腺切除术平均住院时间为2.4天（范围1至4）。肾切除术和肾上腺切除术的平均失血量均为65 mL。从未需要将腹腔镜手术转换为开放手术。仅4例患者发生腹膜渗漏，1例患者发生输尿管损伤。
腹腔镜后腹膜入路对于单纯性肾切除术和小肾上腺肿瘤切除术是安全有效的。围手术期发病率和住院时间均有所减少。
