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目的尝试应用腹腔镜辅助小切口手术完成复杂的泌尿外科手术,总结临床应用体会及操作经验。方法回顾性分析我院2007年8月至2011年6月对3例孤立肾肿瘤、2例单侧多发肾肿瘤、1例双侧肾肿瘤、3例肾肿瘤合并对侧肾功能不全、3例肾盂输尿管连接部梗阻合并多发结石、1例输尿管下段肿瘤,采用腹腔镜辅助小切口手术治疗,探讨手术要点,总结临床诊治经验。结果 9例肾肿瘤患者,手术切口长4～6cm,肾冷缺血时间(15±4)min,手术耗时90～180min。所有患者引流管均于术后48h内拔出。所有患者均未出现出血、尿瘘等严重并发症,术后肾功能正常。3例肾盂输尿管连接部梗阻患者,手术切口长4～5cm,手术耗时110～190min。所有患者引流管均于术后3～5d内拔出,且均未出现出血、尿瘘等并发症。术后拔出双J管后无发热、腰痛等情况,复查静脉肾盂造影,肾盂形态良好,显影正常,无明显肾积水。1例输尿管肿瘤患者,术后3d时拔除引流管,无并发症发生。以上患者术后均未使用术后镇痛泵及镇痛药物。结论腹腔镜辅助小切口手术具有切口小、损伤轻、手术安全性高、肾功能保护好、能处理术中复杂情况等特点,尤其适用于完全腹腔镜处理有困难的病例,也是一种向标准腹腔镜复杂手术过渡的术式。
Objective To apply laparoscopic assisted small incision surgery to complete complex urological surgery, summarize clinical experience and operational experience. Methods A retrospective analysis of our hospital from August 2007 to June 2011 on 3 cases of isolated renal tumor, 2 cases of unilateral multiple renal tumors, 1 case of bilateral renal tumors, 3 cases of renal tumors with contralateral renal insufficiency, 3 cases The ureteropelvic junction obstruction complicated by multiple stones, 1 case of lower ureteral tumors, laparoscopic assisted small incision surgery to explore the main points of surgery, summarize the clinical diagnosis and treatment experience. Results Nine patients with renal tumors had a length of 4 ~ 6 cm and a cold ischemia of 15 ± 4 min. The operation time was 90 ~ 180 min. All patients with drainage tube were pulled within 48h after surgery. All patients did not appear bleeding, urinary fistula and other serious complications, postoperative renal function was normal. 3 cases of ureteropelvic junction obstruction patients, surgical incision length 4 ~ 5cm, time-consuming 110 ~ 190min. All patients with drainage tube were pulled out after 3 ~ 5d, and no bleeding, urinary fistula and other complications. After pulling out double J tube without fever, back pain and so on, review of intravenous pyelography, pyelography in good shape, normal development, no significant hydronephrosis. One case of ureteral tumor patients, drainage tube removed after 3d, no complications. No postoperative analgesia pump and analgesic drugs were used in the above patients. Conclusion Laparoscopic assisted small incision with small incision, less injury, high operative safety, good renal function protection, can deal with intraoperative complications and other characteristics, especially for patients with complete laparoscopic treatment difficulties, but also to a standard Laparoscopic surgery complicated surgical transition.