中文摘要：

目的 探讨经腰腹联合途径腹腔镜手术治疗肾肿瘤的安全性和有效性. 方法 回顾性分析2007年1月至2013年12月收治的100例肾肿瘤患者的临床资料,根据肿瘤大小及手术方式分为4组.4 cm≤肿瘤直径＜7 cm患者60例,行经腰腹联合途径腹腔镜下肾部分切除术30例（A组）,男17例,女13例.平均年龄（49.7±14.5）岁.体质量（65.2± 14.1） kg.肿瘤位于左侧16例,右侧14例.肿瘤大小（4.2±0.9）cm.经腹腔途径腹腔镜下肾部分切除术30例（B组）,男16例,女14例.平均年龄（48.5±13.9）岁.体质量（63.9±15.0） kg.肿瘤位于左侧17例,右侧13例.肿瘤大小（4.3±1.0）cm.肿瘤直径≥7 cm患者40例,行经腰腹联合途径腹腔镜下根治性肾切除术20例（C组）,男11例,女9例.平均年龄（52.3±13.1）岁.体质量（64.4±13.5） kg.肿瘤位于左侧12例,右侧8例.肿瘤大小（8.5±0.9）cm.经腹腔途径腹腔镜下根治性肾切除术20例（D组）,男12例,女8例.平均年龄（53.5±12.8）岁.体质量（65.0±13.6） kg.肿瘤位于左侧10例,右侧10例.肿瘤大小（8.7±0.9）cm.4组手术均采用全麻,A、C组手术体位和操作步骤与经腹膜后途径腹腔镜手术基本相同,仅术中完全打开侧腹膜,连通腹腔和腹膜后腔,扩大手术操作空间. 结果 本研究100例手术均顺利完成,无中转开放.A、B组手术时间分别为（109.5±22.5）、（110.7±23.6） min,热缺血时间分别为（24.0±2.5）、（24.8±2.4） min,估计出血量分别为（61.0±17.0）、（70.0±15.5） ml,需输血例数分别为1、2例,术后恢复进食时间分别为（39.7±6.2）、（52.3±5.8）h,两组比较差异均无统计学意义（P＞0.05）.C、D组手术时间分别为（100.8±21.4）、（106.4±20.5） min,估计出血量分别为（40.0±9.5）、（48.5±9.0） ml,均无输血病例,术后恢复进食时间分别为（41.3±6.4）、（53.7±5.2）h,两组比较差异均无统计学意义（P＞0.05）.4组均未出现术中脏器?

英文摘要：

Objective To explore the safety and efficacy of a new trans-lumbar-and-peritoneally joint （TLPJ） approach for treating renal cell carcinoma by laparoscopic operation.Methods From January,2007 to December,2013,one hundred patients with renal tumor were divided into 4 groups according to the size of tumors and operative approaches.And the clinic information was compared retrospectively.Group A （TLPJ laparoscopic partial nephrectomy） included 17 male and 13 female with average age （49.7±14.5） years old and average weight （65.2± 14.1） kg.The location of tumor included 16 in left kidney and 14 in right kidney.The mean size of tumor was （4.2±0.9） cm.Group B （trans-peritoneal laparoscopic partial nephrectomy） included 16 male and 14 female with average age （48.5±13.9） years old and average weight （63.9±15.0） kg.The location of tumor included 17 in left kidney and 13 in right kidney.The mean size of tumor was （4.3±1.0） cm.Forty patients with tumor size over than 7cm were divided into group C and group D.Group C （TLPJ laparoscopic radical nephrectomy） included 11 male and 9 female patients,with average age （52.3± 13.1） years old and average weight （64.4± 13.5） kg.The mean tumor size was （8.5±0.9） cm.12 tumors were located in the left kidney and 8 in right kidney.average tumor size.Group D （trans-peritoneal laparoscopic radical nephrectomy） included 12 male and 8 female patients with average age （53.5± 12.8） years old and average weight （65.0± 13.6） kg.10 tumors were located in the left kidney and 10 in right kidney.The average tumor size was （8.7±0.9） cm.General anesthesia was applied in all groups.The body position and the surgical approach in group A and C were similar to the retroperitoneal approach.However,the entire side peritoneum was opened to connect the retroperitoneal space with the abdominal space,which largely extended the operative space and was particularly appropriate for the manipulation of the tumors with large size or in spec