摘要
目的 探讨大肾癌根治手术术中并发症发生情况及预防处理措施。 方法 总结89例大肾癌根治术的手术径路及并发症发生情况。男 5 2例 ,女 37例 ,平均年龄 4 9岁。肿瘤直径(9 .8± 1.7)cm ,为T3～ 4N0～ 3 M0 期 ,均接受肾癌根治性切除术。 结果 89例手术中出现并发症2 4例次 ,其中术中死亡 2例 (肺栓塞和鱼精蛋白过敏致DIC各 1例 ) ,脾脏损伤 3例 ,胰腺损伤 2例 ,十二指肠损伤 1例 ,肝脏损伤 3例 ,误扎肠系膜上动脉 2例 ,大出血 11例。行脾切除 2例 ,胰尾切除1例 ,十二指肠造瘘 1例。除 1例患者术后出现胰瘘合并肺部感染死亡外 ,其余均康复出院。 结论 大肾癌根治手术风险高 ,术前三维磁共振血管成像检查有助于手术计划的制订。选择胸腹联合和L形经腹径路及细致的术中操作有助于减少并发症的发生。
Objective To analyze the complications of r adical nephrectomy for large renal carcinoma and to investigate the prevention a nd management for them. Methods The data of 89 patients with large renal carcinoma (52 males and 37 females;mean age of 49 years) were r eviewed regarding their surgical access and occurrence of complications.The mean tumor size was (9.8±1.7)cm in diameter,and the clinical stage was T 3～4N 0～3M 0.All the patients underwent radical nephrectomy. Resul t s Of the 89 patients,24 cases developed complications,including 2 ca ses of death (1,pulmonary embolism and 1,DIC),3 of spleen injury,2 of pancreas i njury,1 of duodenum injury,3 of liver injury,11 of serious bleeding,2 of superio r mesenteric artery injury.The treatment included splenectomy (2 cases),resectio n of the tail of pancreas(1 case),duodenum fistulization (1 case).Only 1 case di ed of pancreatic fistula accompanied by pulmonary infection,the other cases reco vered and were discharged. Conclusions The radical nephr ectomy of large renal carcinoma is of high risk.Preoperative evaluation with thr ee-dimensional MR angiography may help surgeons to plan the operation approach. Appropriate incision (thoracicoabdominal and L-shaped transabdominal access) an d delicate surgical technique can reduce the incidence of operative complication s.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2005年第2期85-87,共3页
Chinese Journal of Urology
