后腹腔镜同期手术治疗双侧肾、肾上腺疾病的临床研究  

Study on retroperitoneal laparoscopic simultaneous operation in the treatment of bilateral kidney and adrenal lesions

作　　者：孟凡敏[1] 邢念增[2] 徐英民[1] 张京东[1] 熊升远[1] 齐强元[1] 

机构地区：[1]临沂市沂水中心医院泌尿外科,山东临沂276400 [2]北京朝阳医院泌尿外科

出　　处：《临床泌尿外科杂志》2014年第4期330-333,共4页Journal of Clinical Urology

摘　　要：目的:探讨后腹腔镜同期手术治疗双侧肾、肾上腺病变的方法和经验。方法:回顾性分析同时发现的需手术治疗的57例双侧肾、肾上腺病变患者,均采用了后腹腔镜同期手术。其中包括双侧肾囊肿去顶减压术21例,一侧肾囊肿去顶减压、对侧肾癌肾部分切除8例,一侧肾囊肿去顶减压、对侧肾上腺手术12例,双侧肾上腺肿瘤同期手术10例,一侧肾上腺手术、对侧肾癌肾部分切除6例。术中均采用了自行研制的实用腹腔后腔扩张器扩张后腹膜腔。结果:57例患者手术全部一次成功。手术时间60~260min,平均140min;术中出血量约20~300ml,平均80ml;术后肠蠕动恢复时间16~32h,平均22h;术后住院时间4~12d,平均7d。术中无大出血、休克、周围脏器损伤等意外发生,患者术后恢复顺利。结论:后腹腔镜同期手术避免了患者二次手术痛苦,缩短了住院时间,节约了医疗费用,在后腹腔镜技术成熟的基础上,选择性开展是安全、有效和可行的。Objective： To evaluate the experience and method of retroperitoneal laparoscopic simultaneous op- eration in the treatment of bilateral kidney and adrenal lesions. Method： All 57 cases of bilateral kidney and adre- nal lesions underwent retroperitoneal laparoscopic simultaneous operation including simultaneous retroperitoneal laparoscopic unroofing of bilateral renal cyst in 21 cases, simultaneous retroperitoneal laparoscopic unroofing of u- nilateral renal cyst and retroperitoneal laparoscopie partial nephrectomy on contralateral kidney in eight cases, sim- ultaneous unroofing of unilateral renal cyst and retroperitoneal laparoscopic adrenalectomy on contralateral adrenal glands in 12 cases, simultaneous operation of retroperitoneal laparoscopic adrenalectomy on bilateral adrenal glands in ten cases, retroperitoneal laparoscopic adrenalectomy on one side and retroperitoneal l^paroscopic partial ne- phrectomy on contralateral kidney in six cases. Self-made practical retroperitoneum dilator was used to expand ret- roperitoneal space in all simultaneous operations. Result： All operations were successfully completed. The opera- tion time was 60--260 （mean, 140） min and blood loss was 20--300 （mean, 80） ml. The time of the recovery of intestinal peristalsis was 16--32 （mean, 22） h and the postoperative hospital stay was 4--12 （mean, 7） d. There was no hemorrhea, shock or serious complications during the operation. All cases recovered well. Conclusion： Retroperitoneal laparoscopie simultaneous operation was a feasible, safe and effective method for the treatment of bilateral kidney and adrenal lesions for experienced endourologists. Furthermore, it can also avoid the second sur- gery, shortened the hospital stay and save the medical expenses.

关 键 词：后腹腔镜 同期手术 双.肾肾上腺病变 实用腹膜后腔扩张器 

分 类 号：R699[医药卫生—泌尿科学]