后腹腔镜治疗肾上腺肿瘤35例临床分析

目的总结后腹腔镜技术治疗肾上腺肿瘤的临床经验.方法采用后腹腔镜切除肾上腺肿瘤35例,男12例,女23例.年龄25岁～72岁,平均49.8岁.左侧15例,右侧20例.其中嗜铬细胞瘤5例,原发性醛固酮增多症10,柯兴氏病2例,神经节细胞瘤2例,无功能性腺瘤16例.腰部取3个套管针穿刺入路,用自制的水囊扩张器扩张后腹腔,用超声刀将肿瘤切除.结果 35例手术均成功,无中转开放手术病例.术中出血量10～500 ml,平均74 ml.病人均未输血.手术时间45～200 min,平均90 min.结论后腹腔镜手术切除肾上腺肿瘤手术效果确切,手术时间短,术中出血少,损伤小,术后恢复快,可以替代绝大多数肾上腺肿瘤开放手术.     

后腹腔镜手术治疗肾上腺囊肿15例报告

目的探讨后腹腔镜手术治疗肾上腺囊肿的方法及临床意义. 方法 2000年3月～2004年5月我院对15例肾上腺囊肿均采用后腹腔镜手术治疗.扩张后腹膜间隙成功后,紧靠膈下纵形切开肾周筋膜,肾周筋膜内分离肾上极和肾上腺周围的脂肪组织,超声刀或电刀在肾表面分离肾脏上极和肾上腺.游离肾上腺行肾上腺部分切除或全切除. 结果 15例手术均获成功,其中肾上腺部分切除术12例,肾上腺全切术3例.手术时间(49.0±31.4)min,术中出血量(31.6±28.7)ml,住院时间(4.1±1.4)d.除1例术后伤口皮下气肿外,无其他术后并发症.15例术后随访(18.5±1.0)月(12～36个月),无一例复发. 结论后腹腔镜手术可作为肾上腺囊肿的首选治疗方法.     

后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿(附29例报告)

目的：探讨后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿的手术方法和疗效。方法：对29例乳糜尿均行经后腹腔镜肾蒂淋巴管结扎术(双侧者只做了一侧)。结果：29例患者手术均成功，平均手术时间110min，术中出血量平均84ml，未见明显的外科并发症，术后平均住院7．9d。患者出院时尿液均清亮，26例单侧乳糜尿患者尿乙醚试验全部阴性。随访1～3年，除1例双侧乳糜尿患者在术后3个月因对侧原因出现乳糜尿外，其余患者均无复发。结论：后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿近期疗效较好．具有术中出血量少、微创、淋巴管结扎彻底、术后住院时间短、恢复快等优点，是目前治疗乳糜尿较理想的手术方式。     

曲卡直接穿刺法建立后腹膜腔气腹行腹腔镜泌尿外科手术的体会

目的：评价用曲卡直接穿刺法建立腹膜后腔气腹，行腹腔镜肾上腺肿瘤切除术及肾脏手术的临床价值。方法：对2002年3月以来开展的64例后腹腔镜泌尿系手术进行分析，本组患者全部采用曲卡直接穿刺法建立后腹膜腔气腹，用后腹腔镜技术完成所有病例。其中肾囊肿去顶减压术45例、肾上腺肿瘤切除术18例、肾切除术1例。结果：除1例肾囊肿去顶减压术因后腹膜腔制备失败改行开放手术外，其余63例手术均获成功。手术时间：肾囊肿30～120min，肾上腺70～140min。1例肾切除210min失血量20～100mL平均50mL，术中及术后均未输血，全部患者均无并发症。结论：曲卡直接穿刺法建立后腹膜腔行腹腔镜肾脏及肾上腺手术具有创伤小、进路直接、易于掌握、几乎无皮下气肿发生、出血少、对腹腔干扰小、术后恢复快等优点，可作为肾上腺良性疾病及部分肾脏疾病手术治疗的首选方法。     

First clinical experience with an endoscopic retroperitoneal approach for anterior fusion of lumbar spine fractures from levels T12 to L5

Background: Recent experience indicates that unstable spine fractures should be stabilized dorsoventrally. To avoid the high morbidity associated with the common anterior approach—i.e., thoraco-phreno-lumbotomy—we developed a technique that allows the anterior fusion of lumbar spine fractures using an endoscopic retroperitoneal (lumboscopic) approach. Methods: Lumboscopic anterior fusion was performed a few days after the initial dorsal stabilization. The retroperitoneal space was accessed endoscopically via a suprailic incision and enlarged using a ballon spacer and CO₂ insufflation. The peritoneum and the kidney were gently pushed ventrally. Mobilization of the psoas muscle dorsally then allowed exposure of the fractured spine bodies. Via two additional trocars placed opposite the fractured level, the damaged disc and bone were removed, and anterior spondylodesis was performed with an iliac crest bone block and a titanium plate. Results: The technique was applied successfully in 12 patients with fractures of L1 (n= 6), L2 (n= 4), L3 (n= 1), and L4 (n= 1) as a mono- or bisegmental fusion, requiring instrumentation from T12 to L5. No major complications (including neurological problems) were encountered. Blood loss was minimal. None of the patients required conversion to open surgery. Patients were mobilized early, starting regularly at the second postoperative day. Conclusions: Lumboscopic instrumentation of the lumbar spine is a safe, minimally invasive method for the treatment of spine fractures. The patients benefit from reduced pain, low morbidity, and excellent cosmetic results. Received: 30 April 1999/Accepted: 2 July 1999     

Technical aspects and access devices for preperitoneal and retroperitoneal endoscopic surgery

The main advantages of preperitoneal and retroperitoneal endoscopic surgery over conventional laparoscopy or open surgery are the decreased risk of injury to organs and reduced postoperative adhesion formation. Exact knowledge of anatomy, as well as correct positioning of the patient, is essential for its success. While a blunt dissection technique, using either the fingers or an endoscope under pneumodissection, is preferred for preperitoneal surgery, the introduction of a balloon dissection device directly into the retroperitoneal cavity simplifies this procedure for retroperitoneoscopy. Different general surgical procedures are described for preperitoneal (hernia) and retroperitoneal (adrenalectomy, neurectomy/ sympathectomy) surgery. Urological/gynaecological procedures (kidney, tumor biopsy, lymphadenectomy) are excluded from this review. In recent years, the number of possible preperitoneal and retroperitoneal surgical procedures has increased, mainly as a result of the development of commercially-available balloon trocars and balloon-tipped trocars, which create and maintain a working space.     

Pressure sensors for the monitoring of diseases in surgical care

Our 10-year experience of retroperitoneal laparoscopic pyelolithotomy, a rarely performed minimally invasive operative procedure, is presented. The results are compared with our own experience of percutaneous nephrolithotomy for larger renal stones. Forty-two patients with a mean age of 39.12 years underwent 43 retroperitoneal laparoscopic pyelolithotomies using Gaur's balloon technique. The total number of stones was 65 (44 pelvic and 21 calyceal) and they ranged in size between 5 and 48 mm. Two patients had chronic renal failure due to bilateral impacted renal calculi. Forty-eight percutaneous nephrolithotomies performed in the same unit during the last 2 years in patients with non-staghorn calculi > 2 cm were included for a comparative study. The open conversion rate and the drainage period for retroperitoneal laparoscopic pyelolithotomy were much higher. However, the operative time, blood loss, analgesic intake, hospital stay, residual stone rate, re-treatment rate and major complication rates were lower, compared with percutaneous nephrolithotomy.     

后腹腔镜肾部分切除术治疗局限性肾癌的疗效分析

目的探讨后腹腔镜肾部分切除术(RLPN)治疗局限性肾癌的疗效和安全性。方法 78例局限性肾癌患者随机分为腹两组,腹腔镜组(RLPN)共45例,开放组(OPN)共33例;记录手术时间,术中出血量、术中热缺血时间、手术前后患肾肾小球滤过率、术后引流量、胃肠道功能恢复时间、术后住院时间、并发症发生率、及肿瘤学效果,并进行统计学分析。结果全部手术均获成功。两组患者在围手术期并发症的发生率、患肾术后肾小球滤过率下降幅度等方面差异无统计学意义,RLPN组与OPN组相比,手术时间及术中肾脏热缺血时间长,差异有统计学意叉(P<0.05);RLPN组出血量、胃肠道功能恢复时间、术后住院天数等方面均明显优于OPN组(P<0.05)。平均随访时间18(1³6)个月,两组患者均未见肿瘤复发及转移。结论与开放术式比较,后腹腔镜下肾部分切除术是一种安全、有效的手术方式,而且具有创伤小、恢复快、住院时间短等优点。