后腹腔镜肾切除术肾蒂的处理(附16例报告)  

Management of the Renal Artery and Vein in Retroper Itoneal Laparoscopic Nephrectomy(Report of 16 cases)

作　　者：王亦农[1] 鲁成军[1] 

机构地区：[1]湖北省秭归县医疗中心泌尿外科,湖北秭归443600

出　　处：《医学新知》2007年第5期277-279,共3页New Medicine

摘　　要：目的探讨后腹腔镜下肾切除术中肾脏血管的处理方法及临床价值。方法腰部3个套管针穿刺入路,自制水囊扩张器扩张后腹腔,肾动、静脉分离尽量远离肾门,分别用Hem-O-Lok夹闭。注意肾动、静脉分离时沿血管纵轴即主干方向游离。结果后腹腔镜下肾切除16例中14例肾动、静脉分离切断过程顺利,1例肾结核肾门严重粘连改为开放手术,1例输尿管癌虽然肾动静脉分离切断顺利,但因髂血管被肿瘤严重侵犯而中转开放手术。手术时间120～240(平均150)min,术中出血30～80(平均70)ml,术后无血管并发症。结论后腹腔镜下肾切除术用Hem-O-Lok夹闭肾动静脉安全有效。Objective To evaluate the surgical technique and the clinical value of the renal artery and vein during retroperitoneal laparoscopic nephrectomy. Methods Totally 16 patients underwent retroperitoneal laparoscopic nephrectomy from August 2004 to May 2007, The operation was performed under a general anesthesia. Patients were maintained in the lateral decubitus position. Two 10 mm trocars and one 5 mm trocarwere introduced into the lumbar part. A selfmade water - filled balloon was used to dilate the retroperitoneal cavity. In the performance of dissection of the renal artery, the renal hilum should be kept away from asmuch as possible. When the artery had been closed for Hem-O-Lok, a linear cutterwas utilized to sever it. Themanagement of the renal vein was identicalwith that for the artery. During the management of the renal artery and vein, utmost care should be exercised to dissect the vessels longitudinally; else they were liable to be ruptured. Results 14 procedures were completed smoothly. 1 patients renal vein to be ruptured, one case of ureteral carcinoma transferred to open surgery. A double artery supply was found in 2 patients. 1 patients had a double venous return-flow. The mean operative time was 150 min （ 120～240 min ）, the mean blood loss was 70 ml （30～80 ml ）.No postoperative vascular comp licationswere observed. Conclusion Use of Hem-O-Lok to sever the renal artery and vein under retroperitoneal laparoscope is safe and reliable.

关 键 词：后腹腔镜 肾切除术 肾动脉 肾静脉 

分 类 号：R699.2[医药卫生—泌尿科学]