腹腔镜技术治疗复发性肾囊肿的探讨

目的：观察应用腹腔镜技术再次治疗腹腔镜肾囊肿去顶术后复发性囊肿的可行性。方法：总结5例腹腔镜技术治疗腹腔镜。肾囊肿去顶术后囊肿复发的临床资料,其中3例经腹腔途径,2例经腹膜后途径。结果：5例患者手术均获得成功。手术时间50～100min,平均75min。出血60～180ml,无并发症发生,术后住院4～9天,术后随访6～14个月,未再复发。结论：对于复发性肾囊肿仍可采取腹腔镜技术进行手术处理。     

后腹腔镜治疗单纯性肾囊肿的探讨(附43例报告)

目的：总结后腹腔镜囊肿去顶术治疗单纯性肾囊肿的经验,讨论手术适应证和手术要点。方法：采用经腹膜后腹腔镜囊肿去顶术治疗肾囊肿患43例、结果：39例手术成功,4例转为开放手术,微小并发症发生率为14％,技术熟练后无并发症发生,2例术后3个月复发．术后平均8d．结论：经腹膜后腹腔镜囊肿去顶术创伤小,患康复快,宜为肾囊肿外科治疗的首选术式。     

腹膜后腔入路腹腔镜肾囊肿去顶术20例

目的探讨腹膜后腔入路腹腔镜下肾囊肿去顶术的技术要点和手术疗效。方法20例患者均在全麻下用自制水囊建立后腹膜腔,距肾实质5mm用电钩或电剪切除囊壁。结果所有囊肿均顺利去顶,手术时间30—90min,平均35min,术中出血量10—80ml,平均30ml,术后平均住院时间3～10天,所有病理报告均为良性病变,随访8～48个月,20例均未见囊肿复发。结论腹膜后腔入路腹腔镜肾囊肿去顶术安全有效。     

经腹膜后腹腔镜囊肿去顶术治疗肾囊肿的初步体会

目的：总结经腹膜后腹腔镜囊肿去顶术治疗单纯性肾囊肿的经验，讨论手术适应证和手术要点，方法：采用经腹膜后腹腔镜囊肿去顶术治疗肾囊肿患者32例，结果：31例手术成功，1例转为开放手术，微小并发症发生率为16％，技术熟练后无并发症发生，1例术后3个月复发，术后平均住院3天，结论：经腹膜后腹腔镜囊肿去顶术创伤小，患者康复快，宜为肾囊肿外科治疗的首选术式。     

腹腔镜肾囊肿去顶术治疗肾盂旁囊肿的体会

目的:总结腹腔镜肾囊肿去顶术治疗肾盂旁囊肿的临床疗效。方法:回顾分析为21例肾盂旁囊肿患者经腹腔入路行腹腔镜肾囊肿去顶术的临床资料。结果:21例手术均获成功,手术时间35～85 min,平均52 min;术中出血量5～40 ml,平均16 ml;无肾蒂、肾盂损伤等并发症发生,平均住院7 d。术后随访3年,1例于术后8个月复发,再次手术;其余患者随访至今均无复发。结论:腹腔镜肾囊肿去顶术治疗肾盂旁囊肿具有患者创伤小、出血少、疗效确切等优点,可作为肾盂旁囊肿的常规治疗方法。     

经腹膜后腹腔镜囊肿去顶术治疗肾囊肿35例临床体会

目的 探讨经腹膜后腹腔镜囊肿去顶术治疗单纯肾囊肿的疗效,并讨论手术适应症和手术要点。 方法 对我科在2005年10月~2010年9月采用经腹膜后腹腔镜囊肿去顶术治疗肾囊肿35例的临床资料进行回顾性分析。 结果 32例手术成功,术中出血量50~250ml（平均80ml）,平均住院时间为7d。在手术开展早期有3例中转开放手术,其中1例膈肌损伤,2例腹膜损伤,技术熟练后无并发症发生。所有患者随访6个月,仅有1例复发。术后恢复快。 结论 经腹膜后腹腔镜囊肿去顶术具有安全、疗效好、创伤小、恢复快的优点,宜作为单纯性肾囊肿外科治疗的首选术式。     

腔镜辅助下肾囊肿去顶术12例

目的：探讨腔镜下囊肿去顶术治疗肾囊肿的方法及疗效。方法：12例麻醉后侧卧位，第12肋尖或肋下2～3cm横切口，手指初步分离，直视或监视器下找到肾囊肿，长柄电刀距肾实质3～5mm将囊肿切除去顶。结果：12例腔镜下肾囊肿去顶术成功，手术时间30～60min，平均40min，术中出血量15～50ml，平均35ml。术后住院2～3d。12例随访3～12个月，平均6个月，囊肿无复发。结论：腔镜下囊肿去顶术治疗肾囊肿操作简单、安全可靠、效果良好。     

俯卧位背侧入路后腹腔镜肾盂成形术治疗肾盂输尿管连接部梗阻的临床价值

目的：探讨俯卧位背侧入路后腹腔镜肾盂成形术治疗肾盂输尿管连接部梗阻（UPJO）的临床应用价值。方法：回顾性分析18例UPJO患者的临床资料。其中男12例,女6例,年龄18～65岁,平均31岁。所有患者行肾脏超声、静脉肾盂造影或多层螺旋CT尿路成像和逆行造影检查,其中2例行逆行造影证实迷走血管压迫,8例无症状患者行同位素肾图证实上尿路梗阻。结果：18例均在后腹腔镜下顺利完成手术。手术时间85～205min,平均125min;术中出血量35～80ml,平均54ml;术后住院6～12天,平均8．7天。围手术期未出现并发症。术后4～6周拔除双J管。随访时间9～20个月,平均14．7月,17例痊愈,总治愈率（94．4％）。1例发生再狭窄,二次行开放手术治愈。结论：俯卧位背侧入路后腹腔镜离断性肾盂成形术治疗UPJ0安全可行。经背侧入路后腹腔镜手术的成功实施为临床手术路径的研究提供一种新的思路。     

后腹腔镜一期手术治疗34例双侧肾囊肿的疗效观察

目的探讨后腹腔镜一期手术治疗双侧单纯性肾囊肿的临床价值。方法对34例后腹腔镜一期行双侧肾囊肿去顶减压患者临床资料进行回顾分析。其中男1例,女13例,年龄17～65岁(34±0.53),囊肿直径5.32±1.31cm,左侧囊肿43个,右侧48个。结果经后腹膜入路34例患者双侧肾囊肿顺利去顶,平均每侧手术时间37.28±0.45min,平均每侧术中出血量7.18±0.53ml,2例随访3～6个月无复发,术中出现单侧腹膜损伤,未伤及腹腔脏器。平均住院天数7.47±0.32d,平均术后住院天数4.10±0.27d。结论后腹腔镜一期行双侧肾囊肿去顶术是一种安全、可行的治疗方式。     

单孔法后腹腔镜下肾囊肿去顶术

目的探讨单孔法后腹腔镜在肾囊肿去顶术中的应用价值。方法采用单孔法后腹腔镜下完成肾囊肿去顶术8例。男5例,女3例。年龄36～67岁,平均42岁。左侧5例,右侧3例。囊肿大小4．6 cm×4．3 cm～7．6 cm×10．2 cm,平均5．6 cm×8．5 cm。结果8例手术均成功,手术时间平均52（45～95）min,术中出血量平均25（0～100）ml,平均1．5（1～4）d拔除引流管,平均1．5 （1～3）d下床活动,术后住院时间平均4．5（3～5）d,8例术后随访1～6个月,经B超和CT或MRI等复查,肾囊肿无复发。结论单孔法后腹腔镜下肾囊肿去顶术具有微创、创口出血少、康复快等优点,具有较高的实用性,安全有效,是治疗肾囊肿的理想术式。     

俯卧位背侧入路后腹腔镜肾上腺肿瘤切除术(附13例报告)

目的:探讨俯卧位背侧入路行后腹腔镜肾上腺肿瘤切除术的疗效及方法。方法:回顾分析2010年6月至2011年3月为13例患者行俯卧位经背侧入路后腹腔镜肾上腺手术的临床资料。其中男9例,女4例,35～57岁,平均45.3岁。术前均行超声、CT或MRI等检查证实为肾上腺占位性病变。病变位于左侧7例,右侧6例。原发性醛固酮增多症8例,嗜铬细胞瘤4例,无功能腺瘤1例。肿瘤直径1.3～4.2 cm,平均2.4 cm。结果:13例均顺利完成手术。手术时间65～125 min,平均89.5 min;术中出血量20～80 ml,平均45.6 ml;术后住院5～8 d,平均6.6 d。围手术期无并发症发生。随访5～14个月,平均10.5个月,未见肿瘤复发及转移。结论:俯卧位背侧入路行后腹腔镜肾上腺肿瘤切除术安全可行。经背侧入路为腹腔镜手术入路提供了新的选择。     

Posterior retroperitoneoscopic adrenalectomy--results of 560 procedures in 520 patients

BACKGROUND: The posterior retroperitoneoscopic adrenalectomy is less popular than the laparoscopic transabdominal method. Due to the direct approach to the adrenal glands, however, the posterior retroperitoneal access is easy to use and may offer advantages not available with other endoscopic procedures for adrenalectomy. METHODS: Between July 1994 and March 2006, we performed 560 adrenalectomies (right side: n = 258; left side: n = 302) by the posterior retroperitoneoscopic approach in 520 patients (200 male, 320 female; age, 10 to 83 years). Of the 520 patients, 21 suffered from Cushing's disease, 499 patients had adrenal tumors (157 Conn's adenomas, 120 pheochromocytomas [13 bilateral], 110 Cushing's adenomas [6 bilateral], and 112 other tumors). Tumor size ranged from 0.5 to 10 cm (mean, 2.9 +/- 1.7 cm). The procedures were performed with the patients in the prone position usually with 3 trocars. RESULTS: Mortality was zero. Conversions to open or laparoscopic lateral surgery were necessary in 9 patients (1.7%). Major complications occurred in 1.3% of patients, minor complications in 14.4%. Mean operating time was 67 +/- 40 min and declined significantly (P < .001) from the early procedures (106 +/- 46 min) to the later operations (40 +/- 15 min). CONCLUSIONS: The posterior retroperitoneoscopic adrenalectomy is a safe and fast procedure. In experienced hands, this method represents the ideal approach in adrenal surgery.     

闭合式经后腹腔镜腔镜肾囊肿去顶

OBJECTIVE: To study the close method of retroperitoneal laparoscopic unroofing of renal cyst. METHOD: A close method retroperitoneal laparoscopic unroofing of renal cyst was attempted in 35 cases between May 1995 and December 1996. The age of the patients ranged from 30 to 72 and the cyst size from 4.0 to 9.3 cm. RESULTS: The operative procedure took around 50 minutes. After a 1 - 18 month follow up, we observed the disappearance of all renal cysts. CONCLUSION: The laparoscopic procedure renders less trauma and discomfort to the patients and may be better indicated for symptomatic, simple renal cysts.     

Laparoscopic unroofing of peripelvic cyst

Laparoscopic unroofing of renal cyst has replaced open surgical intervention in recent years. We report our experience with this procedure on 6 patients with hydronephrosis due to peripelvic cyst. Four male and two female patients, ranging from 51 to 67 years, underwent laparoscopic unroofing of peripelvic cyst. All patients had various degrees of hydronephrosis. Two patients had lumbago and hematuria. The cause of this hematuria was probably due to the renal pelvic stone. Surgical approaches i.e., retro- or transperitoneal were selected depending on the location of cyst. The operative time ranged from 80 to 235 minutes (mean 167 minutes). The length of postoperative hospital stay ranged from 3 to 7 days (mean 4.6 days). Intraoperative blood loss ranged from 20 to 26 cc (mean 21 cc). Four weeks after the operation, all patients showed improvement of hydronephrosis. Laparoscopic unroofing of peripelvic cyst is a safe and efficacious procedure, and could be an' attractive alternative for management of peripelvic renal cysts.     

The role of retroperitoneoscopy in the management of renal and adrenal pathology.

OBJECTIVES: To describe the technique, findings and results of retroperitoneoscopic ablation of recalcitrant renal, giant adrenal and complex peripelvic cysts, and nephrectomy for nonfunctioning congenital anomalous kidneys. PATIENTS AND METHODS: Nine patients (six men and three women, mean age 56 years, range 44-68, five with renal, two with adrenal and two with peripelvic cysts, diameter 6-14 cm) were treated by retroperitoneoscopic cyst ablation using three 10-mm ports. Six further patients (two male and four female, mean age 24 years, range 13-38) underwent retroperitoneoscopic nephrectomy using three or four ports for anomalous nonfunctioning kidneys; three patients had a pelvic kidney, two a horseshoe kidney and one an iliac kidney. Isthmusectomy was also performed in the patients with horseshoe kidneys. RESULTS: Retroperitoneoscopic cyst ablation was successful in all nine patients; the mean (range) operative duration was 69 (50-85) min in patients with simple renal and adrenal cysts, and 185 (160-210) min in patients with peripelvic cysts. The mean (range) blood loss was 130 (50-200) mL and hospital stay 2.33 (2-4) days. At the last follow-up, 15-39 months after the procedure, all patients were asymptomatic and satisfied with the outcome, with no recurrence of cysts. Retroperitoneoscopic nephrectomy with isthmusectomy (when applicable) was successful in the six patients with anomalous kidneys, with a mean (range) operative duration of 105 (85-120) min; the mean (range) blood loss was 116 (75-150) mL and the analgesic requirement 208 (150-250) mg of diclofenac sodium. The hospital stay was 2-3 days and the delay before return to preoperative activity 7-14 days. CONCLUSIONS: Retroperitoneoscopic cyst ablation is a safe and effective method to treat symptomatic cysts of the upper urinary tract which are refractory to other forms of management. Dissection is difficult in patients with peripelvic cysts. Retroperitoneoscopic nephrectomy for anomalous kidneys is a challenging procedure because of the abnormal location, anomalous vessels and presence of an isthmus. With advances in laparoscopy and increasing experience, open surgery for such conditions is likely to become obsolete.     

腹腔镜与开放性肾囊肿去顶术的比较（附30例报告）

目的：比较开放性与腹腔镜肾囊肿去顶术的优越性,并探讨经腹腔与后腹腔腹腔镜肾囊肿去顶术的适应证及疗效。方法：采用经腹腔及后腹腔腹腔镜行肾囊肿去枯术30例,其中经腹腔路径9例,用膜后路径21例,并回顾性分析比较31例开放性肾囊肿去枯术,结果：腹腔镜手术用时25－110min,平均46min,其中经腹腔路矩平均40min,腹后路径平均需时50min,术后恢复快,无一例发生并发症,对比开放手术,腹腔镜手术的手术时间,术后并发症以及术后住院天数均明显减少,结论：腹腔镜肾囊肿去顶术治疗单纯性肾囊肿的疗效明显优于传统开放性手术,值得推广。     

腹腔镜两种径路治疗肾囊肿的体会(附62例报告)

目的:观察腹腔镜下经腹腔和后腹腔两种径路治疗肾囊肿的疗效。方法:本组62例肾囊肿患者,采用经腹腔径路24例,经后腹腔径路38例。结果:本组病例均获成功,手术时间经腹腔途径40~145m in,平均65m in;后腹腔途径35~90m in,平均50m in;术中出血5~25m l,平均14m l;术后24~48h拔除引流管;术后肠功能26~48h恢复,术中、术后均无明显并发症发生,随访2~12个月均无复发。结论:腹腔镜治疗肾囊肿安全有效,与传统开放手术和其他术式相比,具有手术时间短、出血少、康复快、易掌握、术后并发症少等优点。