泌尿外科腹腔镜手术中转开放手术的原因分析

目的:分析泌尿外科腹腔镜手术中转开放手术的原因。方法:回顾分析2004年3月至2006年1月泌尿外科腹腔镜手术81例的临床资料,其中5例(6.2%)中转开放手术。结果:中转开放手术5例包括未能辨明局部解剖关系的首例双侧肾盂输尿管连接部(UPJ)梗阻,术前未能诊断右肾上腺恶性嗜铬细胞瘤浸润肝脏,右输尿管上段结石周围粘连致密分离困难,肾窦内肾盂结石未取出,右肾输尿管结核周围粘连致密暴露困难各1例。结论:熟习腹腔镜下解剖,掌握循序渐进的原则和手术适应证,把握中转开放手术时机及良好的手术设备是提高泌尿外科腹腔镜手术成功率、减少并发症的关键。

Analysis of the causes of urologic laparoscopy converted to open surgery

Objective:To analyze the causes of urologic laparoscopy converted to open surgery.Methods:The data of 81 patients received urologic laparoscopy from March 2004 to January 2006 were reviewed retrospectively.Results:Five operations(6.2%)were converted to open surgery because the local anatomy was not identified laparoscopically in the first patient of UPJO;right malignant pheochromocytoma infiltrating liver was not diagnosed preoperatively(1 patient);dense adhesion around right upper ureter calculus made dissection difficult(1 patient);intratrenal pelvis calculi could not be removed laparoscopically(1 patient),dense adhesion around kidney and ureter caused inadequate exposure in a tuberculosis patient.Conclusions:Acknowledging of anatomy in laparoscopic procedure,thorough understanding of step-by-step principle and operative indication,good judging of conversion to open surgery are essential for improving the success rate and reducing of complication in urologic laparoscopy.