泌尿外科腹腔镜手术中转开放手术的原因分析.DOCVIP

临床医学论文-泌尿外科腹腔镜手术中转开放手术的原因分析 【摘要】? 目的：分析泌尿外科腹腔镜手术中转开放手术的原因。方法：回顾分析２００４年３月至２００６年１月泌尿外科腹腔镜手术８１例的临床资料，其中５例（６１％）中转开放手术。结果：中转开放手术５例包括未能辨明局部解剖关系的首例双侧肾盂输尿管连接部（ＵＰＪ）梗阻，术前未能诊断右肾上腺恶性嗜铬细胞瘤浸润肝脏，右输尿管上段结石周围粘连致密分离困难，肾窦内肾盂结石未取出，右肾输尿管结核周围粘连致密暴露困难各１例。结论：熟习腹腔镜下解剖，掌握循序渐进的原则和手术适应证，把握中转开放手术时机及良好的手术设备是提高泌尿外科腹腔镜手术成功率、减少并发症的关键。 　　【关键词】? 泌尿系疾病；腹腔镜检查；剖腹术 　　Analysis of the causes of urologic laparoscopy converted to open surgery 　　【Abstract】? Ｏbjective:To analyze the causes of urologic laparoscopy converted to open surgery.Methods:The data of 81 patients receiving urologic laparoscopy from March 2004 to January 2006 were reviewed retrospectively.Results:Five patients(6１%)converted to open surgery mainly because that the local anatomy was not identified laparoscopically in the first patient of UPJO,right malignant pheochromocytoma infiltrating liver was not diagnosed preoperatively(1 patient),dense adhesion around right upper ureter calculus made dissection be difficult(1 patient),intratrenal pelvis calculi could not be removed laparoscopically(1 patient),dense adhesion around kidney and ureter caused inadequate exposure in a tuberculosis patient.Conclusions:Acknowledging of anatomy in laparoscopic procedure,thorough understanding of step-by-step principle and operative indication,good judging of conversion to open surgery are essential for improving the success rate and reducing of complication in urologic laparoscopy. 　　【Key words】? Urologic diseases;Laparoscopy;Laparotomy ??? 2004年３月至２００６年１月，我科为８１例肾病患者行腹腔镜手术，５例中转开放手术，现对其原因分析如下。 　　1? 资料与方法 　　１１? 临床资料? ８１例中１例系双侧肾盂输尿管连接部（ureteropelvic junction,UPJ）梗阻，相隔3个月分次手术。男41例，女40例。年龄10～77岁，平均487岁。肾上腺手术19例，瘤体直径10～70cm，其中原发性醛固酮腺瘤11例，嗜铬细胞瘤5例，皮质醇腺瘤1例，髓样脂肪瘤１例，恶性嗜铬细胞瘤1例。肾盂输尿管上段切开取石术16例。肾囊肿去顶术11例，其中１例为双侧。肾盂输尿管离断成形术8例，其中UPJ梗阻3例，输尿管上段结石伴狭窄2例，腔静脉后输尿管1例，输尿管上段瓣膜病1例，输尿管上段开放切开取石术后瘢痕狭窄1例。单纯肾切除术7例，其中巨大肾积水肾脏无功能6例，肾萎缩伴肾性高血压1例。肾癌根治性切除术7例，肿瘤直径42～75cm。肾输尿管全切5例，其中肾盂癌2例，输尿管癌2例，肾输尿管结核1例。乳糜尿行肾蒂淋巴管结扎术2例。肾错构瘤行肾部分切除术2例。精索静脉曲张行精索静脉高位结扎术1例。成人腹腔型隐睾切除术１例。浸润性膀胱癌行根治性全膀胱切除+输尿管皮肤造瘘术1例。前列腺癌行保