应用后腹腔镜再行同侧泌尿系手术的体会  

Subsequent retroperitoneoscopy for patients with previous ipsilateral retropenitoneal surgery

作　　者：孙方浒[1] 韩文胜[1] 洪涛[1] 俞洪元[1] 李飞平[1] 王仙友[1] 蔡仙国[1] 张显军[1] 

机构地区：[1]浙江省台州医院泌尿外科,浙江省临海市317000

出　　处：《中华医学杂志》2013年第20期1583-1584,共2页National Medical Journal of China

摘　　要：目的探讨既往有腹膜后腔手术史的患者再行同侧后腹腔镜手术的可行性。方法选择原有同侧腹膜后腔泌尿系手术史者10例。其中肾囊肿术后复发4例：1例为开放性肾囊肿去顶术后复发，3例为后腹腔镜下肾囊肿去顶术复发。无功能肾6例：肾切开取石术后3例，后腹腔镜输尿管切开取石术后1例，开放性肾盂成形术后2例。距第一次手术时间12～85个月，平均38．6个月。上述患者均行后腹腔镜手术，肾囊肿复发者行肾囊肿去顶术，无功能肾者行患肾切除术。结果手术均成功完成。手术时间平均40～185min，平均97min，术中出血量约20—460ml，平均125ml。术中4例腹膜破裂，其中1例肾腹侧囊肿者，将腹膜裂口扩大，按经腹腹腔镜术式完成手术。术后住院时间3～9d，平均5．6d。9例获随访3—47个月，平均21．5个月，未见并发症。结论对于既往有经胁部入路腹膜后腔手术史者，可选择合适的病例，经腹膜后腔入路行腹腔镜手术。Objective To evaluate the feasibility and clinical results of subsequent retroperitoneoscopic surgery for patients with previous ipsilateral retropenitoneal surgery through frank incision. Methods A total of 10 patents were selected for subsequent laparoscopic surgery through retroperitoneal approach. Among them, there were recurrent renal cysts （ n = 4） including a history of open surgery （ n = 1 ） and retropenitoneal surgery （ n = 3 ） and nonfunctional kidneys （ n = 6 ） including open nephropyelopolasty （ n =3 ） , retroperitoneoscopic nephropyelopolasty （ n = 1 ） and retroperitoneoscopic ureterolithotomy （n = 2）. The mean surgical duration was （12 -85 ） 38.6 months. All patients underwent retroperitoneoscopy. Decortication was performed for renal cysts and nephrectomy for nonfunctional kidneys. Results All operations were successfully performed with a mean surgical duration of 97 （40 - 185 ） minutes and a mean volume of blood loss 125 （20 -460） ml. Among 4 cases with intraoperative peritoneal rupture, one case had renal cyst on ventral side. After enlargement, the procedure was performed through peritoneal cavity. The mean postoperative hospital stay was 5.6 （3 - 9） days. Nine patients received a mean follow-up period of 21.5 （ 3 - 47 ） months. All symptoms were relieved without any occurrence of postoperative complications. Conclusion For patients with previous ipsilateral retropenitoneal surgery, retroperitoneoscopy may be feasible for properly selected cases.

关 键 词：腹腔镜 再手术 泌尿外科手术 

分 类 号：R699[医药卫生—泌尿科学]