观察镜直接分离法建立后腹腔间隙的经验总结及相关并发症的处理(附1511例报告)

Experience about directly laparoscopic separation for establishment of retroperitoneal space and treatment of related complications:with a report of 1511 cases

目的:探讨观察镜直接分离法建立后腹腔间隙的临床经验及相关并发症的处理。方法:回顾分析使用观察镜直接分离法建立腹膜后间隙的1 511例手术患者的临床资料,术中使用Trocar直接穿刺,在观察镜直视下打开气腹机,分离建立腹膜后间隙。观察建立腹膜后间隙的时间、空间大小及腹膜破裂率。结果:1 511例手术中1 502例成功使用IUPU(institute of urology,Peking university)法或改良IUPU法建立腹膜后间隙并施术,其中5例患者分离过程中腹膜破裂导致直接进入腹腔(3例改行经腹腔入路的腹腔镜手术,另2例中转开放手术),其余4例腹膜后间隙成功建立,但由于其他原因中转开放手术,腹膜破裂率0.33%,手术成功率99.40%。近期通过此方法实施的100例手术平均(3.5±1.4)min。结论:观察镜直接分离法建立腹膜后间隙,采用Trocar直接穿刺,在观察镜直视下分离建立腹膜后间隙,操作简便,省时省力,并发症发生率低,更安全可靠,熟练操作腹腔镜的泌尿外科医师可将其作为首选方法。

Objective：To investigate the experience about directly laparoscopic separation for establishment of retroperitoneal space and treatment of related complications. Methods：The clinical data of 1 511 patients whose retroperitoneal space was created by the method of directly laparoscopic separation were retrospectively analyzed. After direct puncturing of the Trocar, the pneumoperitoneum machine was opened under the direct observation of laparoscope, the retroperitoneal space was isolated and established. The time of cre- ating retroperitoneal space, the size of the space and the incidence of peritoneal rupture were recorded. Results：In the 1 511 operations, 1 502 cases of retroperitoneal space were successfully established by using the IUPU （ institute of urology, Peking university） method or modified IUPU method, and the peritoneum of 5 patients ruptured in the process of separating, the peritoneal cavity was directly access- ed （3 cases underwent transperitoneal laparoscopy, and 2 cases were converted to open operation）, the other 4 patients whose retroper- itoneal space was successfully established were converted to the open operation for other reasons. The rate of peritoneum rupture was 0.33% , and the achievement ratio of operation was 99.40%. The average operative time of recent 100 cases with the method was （3.5 ＋ 1.4） min. Conclusions ：The directly laparoscopic separation for establishment of retroperitoneal space includes direct puncturing of the Trocar, isolation and establishment of retroperitoneal space under direct view of laparoscope. The method is safe and reliable, has the advantages of simple operation, short time consumption, low incidence of complications. The method can be used as the preferred method by urological surgeons who have skilled laparoscopic operation techniques.