泌尿外科后腹腔镜手术500例临床分析

Clinical analysis of 500 cases of retroperitoneal laparoscopic operation in urinary surgery

目的：总结泌尿外科后腹腔镜手术经验,提高其临床应用水平.方法：2001年9月至2006年11月为500例患者施行泌尿外科后腹腔镜手术,其中男293例,女207例,9～76岁,平均44.6岁;其中肾上腺手术176例,肾囊肿去顶减压术75例,肾盂切开取石术10例,单纯肾切除术26例,根治性肾切除术31例,肾部分切除术2例,肾输尿管全切术18例,肾蒂淋巴管结扎术9例,输尿管切开取石术9例,输尿管成形术11例,精索静脉高位结扎术133例.并对15例后腹腔镜肾切除术与18例开放式肾切除术进行比较.结果：484例（96.8%）完成手术,其中1例因大出血于手术次日行开放手术;术中膈肌穿孔1例,术后切口感染6例,无大血管破裂、腹腔内脏器损伤、死亡等并发症发生;中转开放手术16例.肾切除手术中,后腹腔镜组的术中出血量及术后患者康复时间少于开放组.结论：后腹腔镜手术适于治疗肾上腺、肾、输尿管及精索静脉疾病,具有患者创伤小、安全、术后康复快等优点,可作为有适应证患者的首选手术方法.

Objective：To summarize the clin/cal experience of retroperitoneal laparoscopic operations in urinary surgery and facilitate the clinical application. Methods： From September 2001 to November 2006, 500 patients underwent retroperitoneal laparoscopic operations in urinary surgery,including 293 men and 207 women. The average age was 44.6 years （range from 9-76 years）. There were 176 adrenal gland operations ,75 renal cyst decompression procedures, 10 pylvilithotomy,26 simple nephrectomy ,31 radical nephrectomy,2 partial nephrectomy, 18 nephroureterectomy, 9 ligation of renal pedicle lymphatic, 9 ureterolithotomy, 11 ureteroplasty, and 133 varicocele ligation. 15 retroperitoneal laparoscopic nephrectomes were compared with 18 open nephrectomy. Results： In 484 patients （96.8%）, the procedures were performed successfully. Among them, only one patient had to undergo open surgery the day after operation due to huge bleeding. Diaphragma perforation intraoperatively occurred in 1 case, and infection of incision in 6 cases. There were no severe complications such as organ injuries and mortality. Sixteen patients （ 3.2% ） had to be converted to open surgery because of uncontrollable bleeding or hard manipulation. Retroperitoneal laparoscopic nephrectomy had less estimated blood loss and quicker recovery compared with the open approach. Conclusions ： Retroperitoneal laparoseopy can be applied very well in the operation of adrenal gland, kidney,ureter and vena spermatica. It has advantages of minimal invasion, safety and rapid recovery, so can be regarded as the first choice for patients with indications in urinary surgery.