后腹腔镜手术治疗泌尿外科疾病初步经验(附68例报告)

Laparoscopic management of urologic disease: primary clinical experience with 68 cases.

目的 探讨后腹腔镜手术治疗泌尿外科疾病初期阶段适应症选择、注意事项及治疗效果。方法 2001年11月-2003年5月共开展后腹腔镜泌尿外科手术68例。其中肾上腺手术16例(原醛11例,嗜铬细胞瘤2例,无功能腺瘤2例,肾上腺囊肿1例)、肾切除术5例(肾结核1例,肾癌1例,肾盂癌2例,巨大肾积水1例)、肾囊肿去顶手术47例。结果 68例腹腔镜手术均获成功。肾上腺手术和肾切除术术中出血30-150ml,肾囊肿去顶术术中出血少于50ml,全部手术无1例术中输血。并发症发生率为26.4％(18/68),其中皮下气肿12例、腹膜损伤4例、腹膜后血肿1例、术后活动性出血1例。多数并发症无需特殊处理。患者术后住院时间3-10天。结论 后腹腔镜手术具有切口小、出血少、恢复快、住院时间短等优点,但使用初期应强调手术人员的泌尿外科手术基础、腹腔镜操作演练和严格把握适应症。

AIM To discuss the primary clinical experience and the effect of laparoscopic management of urologic disease. METHODS From November 2001 to May 2003, 68 patients underwent retroperitoneal laparoscopic adrenalectomy or tumor enucleation (16/68),nephrectomy (5/68), marsupialization of the renal cyst (47/68). RESULTS Retroperitoneal laparoscopy was successfully applied in 68 cases. The bleeding volume were 30~ 150ml in retroperitoneal laparoscopic adrenalectomy/tu-mor enucleation or nephrectomy,less than 50ml in marsupialization of the renal cyst. No patient need blood transfusion. The rate of complications was 26.4% (18/68). Most of the complications need not management. The postoperative hospitalization was 3-10 days. CONCLUSIONS Laparoscopic management of urologic disease has the advantages of minimal invasion, less blood loss, quicker recovery and shorter hospitalization. The background of open urologic surgery, experienced operation of laparoscopic instruments and strict selection of patients are very important for new user.