后腹腔镜技术在肾上腺及上尿路疾病中的应用

目的探讨后腹腔镜手术治疗肾上腺及上尿路疾病的临床效果及手术技巧。方法采用后腹腔镜手术治疗肾上腺及上尿路疾病136例,其中肾囊肿去顶减压术68例,肾上腺手术15例(原发性醛固酮增多症4例,嗜铬细胞瘤4例,皮质醇腺瘤2例,神经纤维瘤2例,无功能皮脂腺瘤2例,皮质增生1例),单纯性肾切除术15例,肾癌根治性肾切除术8例,肾盂癌肾输尿管全切术5例,肾盂输尿管成型术3例,输尿管切开取石术12例。结果 134例获得成功,转开放手术5例,无严重并发症发生,疗效满意。结论后腹腔镜手术具有创伤小、出血少、疼痛轻、恢复快等优点,清理腹膜后脂肪为手术提供了较好的视野及空间,通过腰大肌及膈肌脚寻找输尿管及肾动脉方法可靠。

Application of retroperitoneal laparoscopic surgery in adrenal gland and upper urinary tract diseases

Objective To investigate the clinical effect and technique of retroperitoneal laparoscopic surgery in treating adrenal gland and upper urinary tract diseases.Methods One hundred and thirty-six patients with urological diseases were operated by retroperitoneal laparoscopic surgery,including 68 cases of renal cyst decortication,15 cases of adrenal tumor surgery（4 cases of primary aldosteronism,4 cases of pheochromocytoma,2 cases of corticosteroid adenoma,2 cases of neurofibroma,2 cases of nonfunctional adrenocortical adenoma,1 case of corticohyperplassia）;15 cases had simple nephrectomy,8 cases had radical nephrectomy,5 cases had nephroureterectomy,3 cases had pyeloureteroplasty,12 cases had ureterolithotomy.Results One hundred and thirty-four cases accomplished retroperitoneal laparoscopic surgery,5 cases converted to open surgery.There was no serious complications in these cases.Conclusion Compared with open surgery,retroperitoneal laparoscopic surgery has the advantages of minimal invasion,less blood loss,mild pain,quicker recovery.Cleaning retroperitoneal fat can provide better visual fields and interspace.It is a reliable method to find the ureter and renal artery through psoas muscle and crura of diaphragm.