县级医院泌尿外科腹腔镜手术1000例报道

Clinical analysis of 1000 urologic laparoscopic operations in county hospital

目的总结基层医院泌尿外科开展腹腔镜手术技巧和经验教训。方法回顾分析2003年4月至2011年4月8年来采用后腹腔镜手术的治疗泌尿外科疾病1 000例患者的临床资料。其中肾上腺肿瘤手术43例;肾盂、输尿管切开取石366例,乳糜尿肾蒂淋巴管剥脱术227例,单纯性肾切除73例,肾癌根治性肾切除28例,肾盂癌根治术8例,小肾肿瘤剜除术13例,重复肾切除术6例,肾盂成形术18例,肾囊肿去顶减压术205例,肾盏憩室2例;腔静脉后输尿管成形术4例;腹膜后肿瘤切除术7例(淋巴管囊肿2例、腰大肌腱鞘囊肿1例、异位嗜铬细胞瘤2例、肾门脂肪瘤1例、腹膜后苗勒管囊肿1例)。结果手术成功983例,转开放手术17例。无大出血病例,手术主要并发症有复发、漏尿、双J管异位、结石残留。CO2血症酸中毒昏迷1例。结论基层医院广泛开展泌尿外科腹腔镜手术是安全有效可行的。只有经过大量手术经验的积累,才能更加体现腹腔镜手术痛苦小、恢复快等微创优势。

Objective To summarize the technique and experience of urologic laparoscopic operations in our hospital. Methods The clinical data of 1 000 cases undergone retroperitoneal laparoscopic operation during April 2003 to April 2011 were retrospectively analyzed. 43 patients received surgery of adrenal gland neoplasms, 366 pyelolithotomy or ureterolithotomy, 73 simple nepbrectomy, 28 radical nephrectomy, 8 radical nephroureterectomy, 13 renal tumur enucleation, 6 nephrectomy for duplex kidney, 18 nephropyelopolasty, 205 renal cyst decortication, 2 renal caliceal diverticulectomy, 4 postcaval ureteroplasty, 7 retroperitoneal tumor resection （1 lymphatic cyst, 2 ganglion cyst of psoas major muscle, 2 ectopic pheochromocytoma, 1 reniportal lipoma and 1 Mullerian duct cyst）. Results 983 cases of：laparoscopic surgery were successful, while 17 cases were converted to open surgery. No massive hemorrhage occurred. The main complications included recurrence, urine leakage, allotopia of double-J tube and residue of calculus. 1 case developed coma because of hypercapnemia. Conclusions It is a safe and feasible procedure for basic level hospitals to carry out urologic laparoscopic operations. The advantages of less injury and quicker recovery of this minimaliy invasive procedure make it the best choice if the surgeons are qualified.