腹腔镜技术在泌尿外科中的应用总结(附509例报告)

泌尿外科腹腔镜技术近10余年来取得了飞速发展,但临床上关于手术的许多具体问题仍有分歧,值得探讨.1998年10月至2006年8月,我科采用腹腔镜技术治疗泌尿系疾病共509例,取得较好效果,得到一些经验,供同行参考.(1)手术入路:与腹腔入路相比,后腹腔入路能迅速进入术野,且可更多地借鉴开放手术经验,因此除少数高难度及需要同时处理双侧病变的患者外,建议一般采用后腹腔入路.(2)肾脏切除手术:肾癌手术应于脂肪囊外游离,完整将肾切除,包括肾门周围淋巴组织;＞10 cm的肿瘤或伴有癌栓者考虑开放手术;除上极肿瘤外,不考虑切除肾上腺;行肾盂肿瘤根治术时应防止肿瘤细胞沿输尿管种植.肾切除术中须仔细分离肾脏血管,建议首先以hemo-lock夹闭肾脏动脉.(3)肾上腺手术:腹腔镜肾上腺切除术是肾上腺手术的"金标准",必须根据肾上腺疾病的性质、部位、累及范围和血供特点选择手术方式、手术范围以及相应的术前准备.(4)其他:对前列腺癌根治术等较高难度手术建议根据医生腹腔镜操作的熟练程度和患者身体状况决定是否采用腹腔镜手术;对于精索静脉曲张手术,由于开放手术能较好解决问题,不主张腹腔镜手术.

Application of laparoscopic surgery in urology: an experience with 509 cases

The last ten years have witnessed a rapid development in laparoscopic surgery for urology,but there are still many specific problems need to be discussed concerning the operation procedures.From October 1998 to August 2006,509 patients have received laparoscopic surgery in our department.Our experience is summarized as following:(1) Compared with the peritoneal approach,the retroperitoneal approach is faster in exposing the operative field and more experience from the open operation could be used,so retroperitoneal approach should be recommended unless for a few difficult cases or cases need to be treated bilaterally.(2) In radical nephrectomy,the kidney should be completely removed including the lymph nodes.Open operation should be considered if the diameter of the tumor is more than 10 cm.Adrenal gland resection should not be considered unless the tumor locates in the upper pole.In radical resection of the renal pelvic carcinoma,attention must be paid to prevent tumor metastasis into the ureter.The kidney vessels must be separated in the nephrectomy operation and the use of hemo-lock is recommended to block the kidney artery.((3) Laparoscopy) is a golden standard for adrenalectomy;the operation procedure should be chosen according to the property,location,involvement,and blood supply of the tumors.(4) Whether to use laparoscopic surgery or not for patients warranting difficult surgeries such as radical prostatectomy should be decided considering the general condition of the patients and the skills of the surgeons.As for operations for varicocele,we do not recommend laparoscopic surgery because it can be readily treated with open operation.