泌尿外科腹腔镜手术改行开放手术的原因浅析

Analysis of the causes of laparoscopic converted to open surgery in urology

目的 分析泌尿外科腹腔镜手术改行开放手术的原因。 方法 对 16 5例泌尿外科腹腔镜手术患者的临床资料进行分析 ,其中 2 6例 (16 % )改行开放手术。 结果 2 6例改行开放手术原因 :未找到病灶 8例 ,气腹或腹膜后充气不满意 5例 ,粘连分离困难 5例 ,出血 4例 ,损伤周围脏器 2例 ,设备故障 2例。不同疾病改行开放手术的比例分别为肾上腺手术 42 % (8/19) ,肾切除术 2 5 % (2 /8) ,肾囊肿去顶术 18% (11/6 1) ,前列腺癌盆腔淋巴结活检术 17% (1/6 ) ,精索静脉结扎术 3% (2 /6 0 ) ,隐睾探查术 19% (2 /11)。 结论 掌握适应证和手术入路、熟练操作技术。

Objective To analyze the causes of laparoscopic converted to open surgery in urology. Methods The study included 165 patients undergoing urologic laparoscopic surgery in our institute. A total of 26 patients(16%) converted to open surgery during the procedure. Results The primary causes of conversion to open surgery were missed target in 8 patients, discontent of intraperitoneal or retroperitoneal insufflation in 5, adherence in 5,hemorrhage in 4,injury of organ in 2 and malfunction of instruments in 2 cases. Different laparoscopic procedures had different proportion of conversion to open surgery.In laparoscopic adrenalectomy 42% of patients converted to open surgery (8/19), 25% in nephrectomy(2/8), 18% in renal cyst excision(11/61), 17% in pelvic lymphadenectomy of prostatic cancer(1/6),3% in varico- celectomy (2/60) and 19% in orchiectomy(2/11). Conclusions Selection of proper indication and laparoscopic approach, improvement of skill and adequate instruments are essential for urologic laparoscopy.