泌尿外科腹腔镜手术并发症临床分析

Clinical analysis of laparoscopic complications in urologic surgery

目的探讨泌尿外科腹腔镜手术并发症的原因及防治。方法2000年5月至2004年5月,施行泌尿外科腹腔镜手术135例,其中经腹腔途径17例,经后腹膜腔途径118例。行简单腹腔镜手术48例(A组),包括肾囊肿去顶减压术31例,精索静脉曲张结扎12例,隐睾探查及复位固定术5例。行复杂腹腔镜手术87例(B组),包括肾上腺腺瘤摘除26例,根治性肾切除25例,肾盂成形术6例,肾包膜部分切除加大网膜包裹术2例,肾部分切除术2例,肾盂输尿管全长切除4例,肾蒂淋巴管结扎13例,输尿管松解术2例,输尿管切开取石7例。回顾性调查所有病例的术中及术后并发症并作临床分析。结果共发生并发症14例(10.4%)。发生术中并发症10例,其中腹膜损伤6例,均于术中行钛夹夹闭；出血4例,均迅速中转开放手术。术后并发症4例,其中皮下气肿2例,分别于术后5d和7d自行吸收；切口渗液1例,持续引流40d后痊愈；尿潴留1例,保留导尿3d后自行排尿。无死亡病例。A、B组并发症发生率分别为4.2%(2/48)和13.8%(12/87),P＜0.05。结论了解腹腔镜手术并发症的特点,通过系统的操作训练,可减少泌尿外科腹腔镜手术并发症的发生。

Objective To evaluate the causes,prevention and treatment of laparoscopic complications in urologic surgery. Methods From May 2000 to May 2004,135 urologic laparoscopies were performed,including 17 transperitoneal laparoscopies and 118 retroperitoneal laparoscopies. Of the135 cases,26 had adrenal adenoma extirpation;31 had roof-removal and decompression of renal cyst;25 had radical nephrectomy;6 had pyeloplasty;2 had partial resection of renal capsula and encapsulation of the great omenturn ;2 had partial nephrectomy;4 had pelviureteral resection;13 had ligation of renal pedicle lymphatic vessel;2 had ureterolysis;7 had ureterolithotomy; 12 had ligation of spermophlebectasis;5 had exploration, reduction and fixation of undescended testis. The intra- and post-operative complications were retrospectively reviewed and clinically analyzed. Results Overall,14 cases （ 10.4% ） had complications. Intraoperative complications occurred in 10 cases, including 6 cases of peritoneal injuries, which were clamped during operation; 4 of vascular injuries, which resulted in conversion to open surgery. Postoperative complications occurred in 4 cases,including 2 of subcutaneous emphysema, which was spontaneously absorbed at 5 and 7 d after operation;1 of incision seepage, which was drained for 40 d and then disappeared;and 1 of urine retention,for which urethral catheterization was kept for 3 d and then the patient had voluntary voiding. No death occurred in this series. Conclusions Understanding the characteristics of laparoscopic complications in urologic surgery and systematic training of the surgeons can reduce the occurrence of complications.