后腹腔镜上尿路手术中腹膜破裂的原因及处理

目的探讨后腹腔镜上尿路手术致腹膜破裂的原因及处理方法。方法对2010年2月—2013年10月收治并行后腹腔镜上尿路手术致腹膜破裂14例的临床资料进行回顾性分析。结果本组行根治性肾切除术5例,肾上腺肿瘤切除术3例,单纯肾切除术、肾部分切除术、肾输尿管全长切除术各2例。腹膜破裂的时间分别为切开侧锥筋膜时3例,建立后腹腔间隙、盲穿腹侧穿刺套管、分离肾脏腹侧粘连处腹膜、分离肾上腺腹侧、器械插入误伤腹膜各2例,清理腹膜外脂肪时损伤腹膜1例。通过Hem-o-lok夹直接夹闭(9例)、腹腔套管排气(5例)、缝合(4例)、手助腹腔镜(1例)等方法处理,恢复腹膜后手术空间,均顺利完成手术。结论掌握好处理腹膜破裂的技巧并及时处理,可减少手术时间,避免并发症的发生,有利于顺利完成手术。

The Reasons and Treatments of Peritoneal Rupture in Upper Urinary Tract Surgery by Retroperitoneal Laparoscopy

Objective To investigate the reasons and treatments of peritoneal rupture in upper urinary tract surgery by retroperitoneal laparoscopy. Methods Fourteen patients had peritoneal rupture in upper urinary tract surgery by retroper-itoneal laparoscopy from February 2010 to October 2013, and their clinical data was retrospectively analyzed. Results Of fourteen patients, five patients underwent radical nephrectomy, three patients underwent excision of adrenal tumor, two pa-tients underwent simple nephrectomy, two patients underwent partial nephrectomy, and two patients underwent nephroureterec-tomy;Peritoneal rupture occurred in the time of slitting side of the cone fascia in three cases, cleaning up extraperitoneal fat in one patient, and two cases each in the time of establishing retroperitoneal space, blind abdominal puncture cannula operation, harming peritoneal with devices, dissociating peritoneal adhesions at the ventral kidney damage and dissociating adrenal ven-tral. The treatments for peritoneal rupture were performed to restore the operation space, such as direct closuring with Hem-o-lok （ nine patients） , discharging gas from abdomen （ five patients） , suturing gap （ four patients） , and turning to hand-assis-ted laparoscopy （ one patient） . And all patients were completed the surgeries successfully. Conclusion Marstering the treat-ment skills of peritoneal rupture and dealing with it quickly may reduce operation time, avoid complications and contribute to completing surgery successfully.