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泌尿外科腹腔镜技术近10余年来取得了飞速发展,但临床上关于手术的许多具体问题仍有分歧,值得探讨。1998年10月至2006年8月,我科采用腹腔镜技术治疗泌尿系疾病共509例,取得较好效果,得到一些经验,供同行参考。(1)手术入路:与腹腔入路相比,后腹腔入路能迅速进入术野,且可更多地借鉴开放手术经验,因此除少数高难度及需要同时处理双侧病变的患者外,建议一般采用后腹腔入路。(2)肾脏切除手术:肾癌手术应于脂肪囊外游离,完整将肾切除,包括肾门周围淋巴组织;>10 cm的肿瘤或伴有癌栓者考虑开放手术;除上极肿瘤外,不考虑切除肾上腺;行肾盂肿瘤根治术时应防止肿瘤细胞沿输尿管种植。肾切除术中须仔细分离肾脏血管,建议首先以hemo-lock夹闭肾脏动脉。(3)肾上腺手术:腹腔镜肾上腺切除术是肾上腺手术的“金标准”,必须根据肾上腺疾病的性质、部位、累及范围和血供特点选择手术方式、手术范围以及相应的术前准备。(4)其他:对前列腺癌根治术等较高难度手术建议根据医生腹腔镜操作的熟练程度和患者身体状况决定是否采用腹腔镜手术;对于精索静脉曲张手术,由于开放手术能较好解决问题,不主张腹腔镜手术。
Urology laparoscopic technology has achieved rapid development over the past 10 years, but many specific issues on the operation of the surgery are still divided, it is worth exploring. From October 1998 to August 2006, our department used laparoscopic techniques to treat 509 cases of urinary diseases, achieved good results and gained some experience for peer reference. (1) surgical approach: Compared with the abdominal approach, the posterior abdominal approach can quickly enter the operative field, and can learn more from the experience of open surgery, so in addition to a handful of difficult and need to treat bilateral lesions in patients, It is recommended to use the retroperitoneal approach. (2) Nephrectomy: renal cancer surgery should be free outside the fat capsule, the complete nephrectomy, including the perineal lymphoid tissue;> 10 cm of the tumor or associated with thrombus to consider open surgery; in addition to the pole of the tumor, Excision of the adrenal does not consider; line renal pelvis tumor radical surgery should prevent the planting along the ureter. Nephrectomy should be carefully separated from the renal blood vessels, it is recommended to first clamp the renal artery hemo-lock. (3) Adrenal Surgery: Laparoscopic adrenalectomy is the “gold standard” for adrenal surgery. The surgical methods, the scope of surgery and the corresponding preoperative preparation must be selected according to the nature, location, extent of involvement and blood supply of the adrenal disease. (4) others: radical prostatectomy and other difficult surgical advice according to the doctor’s proficiency in laparoscopic operation and the patient’s physical condition to decide whether to use laparoscopic surgery; varicocele surgery, due to open surgery can better solve the problem , Do not advocate laparoscopic surgery.