解剖性腹膜后间隙的建立及扩大在经后腹腔镜手术中的应用

The application of the building and expansion of anatomically retroperitoneal space in urologic surgery

目的探讨在泌尿外科经后腹腔镜手术中,腹膜后间隙的建立、确定及扩大对肾上腺、肾脏、输尿管等脏器疾病的手术应用。方法根据腹膜后间隙解剖学研究的层次特点,建立、确定及扩大镜下腹膜后间隙,经腹膜后方向入路,对68例肾上腺、肾脏、肾盂与输尿管等疾病患者实施腹腔镜手术治疗。结果 68例手术中顺利建立了相应的腹腔后间隙,完成了相应手术;5例发生腹膜穿破,无中转开放手术,无输血及其它严重并发症发生。结论腹膜后间隙是泌尿外科微创手术的重要入路,关键是解剖学标志、结构层次的镜下确定,间隙内具有足够操作空间、满足腹膜后泌尿外科手术、手术安全性较高、并发症少等优点。

Objective To explore the practical effects of surgery in treating such diseases as in the adrenal gland, the kidneys, and in the ureter with the establishment, determination and direction expansion of the anatomical retroperitoneal space in urological surgery with laparoscope. Methods Operations with laparoscopy were performed on 68 cases with the adrenal gland, kidney, pelvis and ureter diseases at the direction of the retroperitoneum after the establishment and determination and expansion of the peritoneal interval based on its clinical and anatomical characteristics. Results Relevant retroperitoneal gaps were established successfully in the 68 cases and the operations were well completed. Perforation happened in 5 cases without conversion to open surgery, or blood transfusion and other serious complications. Conclusion Retroperitoneal space is an important access in urological minimally invasive surgery. The key lies in the establishment of anatomic landmarks, the determination of the level of the structure, and sufficient space for operation inside the cavity, thus it can show the advantages of urological surgery with laparoscope as being safe, with few complications, quick recovery and clinically practice.