后腹腔镜术中腹膜反折的辨识与腹膜损伤处理方法  

Identification of peritoneal reflection and treatment of peritoneal injury in retroperitoneal laparoscopic surgery

作　　者：门群利 郭刚[1] 蔡伟[1] 祝强[1] 刘鹏[3] 张旭[1] 

机构地区：[1]中国人民解放军总医院泌尿外科,北京100853 [2]宝鸡市中心医院泌尿外科 [3]榆林市第一医院泌尿外科

出　　处：《微创泌尿外科杂志》2014年第2期96-99,共4页Journal of Minimally Invasive Urology

基　　金：国家高技术研究发展计划(2012AA021100)

摘　　要：目的：分析后腹腔镜术中腹膜反折的解剖特点及发生腹膜损伤的原因，探讨后腹腔镜术中腹膜损伤的预防与处理方法.方法：回顾2013年2月~2013年10月在中国人民解放军总医院泌尿外科实施后腹腔镜手术483例患者资料，并对术中腹膜损伤发生情况、发生部位及处理办法进行统计，结合文献复习分析与腹膜损伤相关的后腹腔解剖学特点.结果：共有53例患者在术中发生腹膜损伤，发生率11.0％.其中男37例，女16例，年龄19~78岁，平均58.3岁.左侧21例，右侧32例，损伤位于膈下区9例，肾脏腹侧区41例，髂窝区3例.术式包括肾切除手术40例，肾上腺手术8例，肾盂及输尿管手术5例.因后腹腔空间制备及套管放置引发损伤8例，因术中操作不当引发损伤45例，所有腹膜损伤均未累及腹腔脏器.腹膜损伤后，充分游离破口周围腹膜，用吸引器洗净腹腔积气，待破口闭合后用分离钳夹闭破口，再以 He m-o-l ok 夹关闭破口.对于较大的破口，可先行腹腔穿刺持续减压，再以 He m-o-l ok 夹关闭破口或丝线连续缝合.53例手术均顺利完成，术后未见腹膜损伤相关并发症.结论：腹膜损伤是后腹腔镜术中较常见的并发症，对于后腹腔腹膜反折的正确辨识可有效减少腹膜损伤的发生，同时多种方法可以有效处理腹膜损伤.To analyze the anatomical features of reflection in retroperitoneal laparoscopy and reasons of peritoneal rupture ,and explore the prevention and treatment of intraoperative peritoneal rupture in retroperitoneal laparoscopy .Methods :Peritoneal rupture status ,location and treatments in 483 patients from 2013 February to 2013 October in Chinese PLA General Hospital were retrospecti vely analyzed .Retroperitoneal anatomical characteristics of peritoneal rupture were studied through the literature review.Results :Fifty-three patients (37 males ,and 16 fe-males )with the age of 19-78 years old experienced intraoperative peritoneal rupture in retroperitoneal laparoscopic surgery with the incidence being 11.0 %.There were 21 cases on the left side ,and 32 on the right side .The perito-neal rupture was located under the diaphrag min 9 cases ,in kidney ventral area in 41 cases ,and in renaliliac fossa area in 3 cases .Forty cases under went nephrecto my ,8 cases adrenalecto my ,and 5 cases renal pelvis and ureter sur-gery .Peritoneal rupture occurred during the retroperitoneal preparati on and trocar placement in 8 cases ,and in 45 cases odue to improper operati on .All of these cases did not experience intraoperative peritoneal lesions .After perito-neal rupture ,the peritoneal around the crevasse was fully dissociated ,abdo minal pneu matosis was ter minated ,the peritoneal crevasse cli pped with separating pliers after lacerati on occl usi on ,and finally the peritoneal crevasse was cli pped with He m-o-l ok .For larger crevasse ,the abdo minal pressure was deco mpressed through abdo minal puncture with silk ,then peritoneal crevasse was cli ppd with He m-o-l ok or sutured .Fifty 53 cases of peritoneal rupture suc-cessfully under went retroperitoneal laparoscopic surgery without postoperative peritoneal rupture-related co mplica-ti ons .Conclusions :Peritoneal rupture is a common complicati on during retroperitoneal laparoscopic surgery .The inci-dence of the peritoneal rupture can be effecti vely reduced probably by

关 键 词：后腹腔镜 腹膜损伤 解剖 

分 类 号：R572[医药卫生—消化系统]