【摘要】：通過對腹膜后腔筋膜間隙層面解剖的研究總結(jié),在后腹腔鏡根治性腎切除術(shù)中尋找安全正確的解剖層面,進(jìn)行無血化解剖性手術(shù)操作,改進(jìn)游離、切除腎臟的手術(shù)技巧。2016年3月~2017年3月收治61例局限性腎癌患者,其中左側(cè)33例,右側(cè)28例;腫瘤直徑3.4cm~7.5cm,平均5.6cm。通過尋找顯露腎旁前間隙、腰肌前間隙、腎筋膜前葉腎前融合筋膜間隙等無血管平面,實(shí)施無血化解剖性腎切除手術(shù)。61例手術(shù)均獲成功,無中轉(zhuǎn)開放手術(shù)。手術(shù)時(shí)間43min~98min,平均61min;出血量30ml~150ml,平均75ml;術(shù)后4d~8d出院。7例發(fā)生腹膜破裂,5例發(fā)生腎上腺腺體輕微撕裂,少量出血,無輸血,無其他嚴(yán)重并發(fā)癥發(fā)生。根據(jù)腹膜后腔筋膜間隙層面解剖的特點(diǎn),通過辨認(rèn)及分離腎旁前間隙、腰肌前間隙、腎筋膜前葉腎前融合筋膜間隙等無血管層面,可充分顯露手術(shù)空間,在直視下辨別毗鄰關(guān)系,可無血化解剖性實(shí)施手術(shù),術(shù)中出血少,避免周圍毗鄰臟器損傷及大出血等并發(fā)癥。該方法安全有效、節(jié)省時(shí)間,值得在臨床推廣應(yīng)用。
[Abstract]:Based on the study of retroperitoneal fascial space anatomy, a safe and correct anatomical layer was found in retroperitoneal laparoscopic radical nephrectomy, and anatomic operation without blood was performed to improve the dissociation. Surgical techniques for nephrectomy. From March 2016 to March 2017, 61 patients with localized renal cell carcinoma were treated, of whom 33 were left and 28 were right, and the diameter of the tumor was 3.4 cm to 7.5 cm, with an average of 5.6 cm. No vascularization was performed in 61 cases of anatomic nephrectomy with no vascularization, no conversion to open surgery, by searching for vascular plane to expose the anterior space of parafronephric space, anterior psoas space, anterior renal fascia fusion space, and so on. The operative time was 43 min to 98 min (mean 61 min), the volume of bleeding was 30 ml / 150 ml (mean 75 ml), and there were 5 cases of 4d~8d discharged from hospital with slight rupture of adrenal gland, small amount of bleeding, no blood transfusion and no other serious complications. According to the anatomical characteristics of retroperitoneal fascial space, the surgical space can be fully exposed by identifying and separating the paraspinephric space, the anterior psoas space, the anterior renal fascia fusion fascia space, and so on. Under direct vision, there is no blood anatomical operation to distinguish the adjacent relationship, the bleeding is less during the operation, and the complications such as adjacent organ injury and massive hemorrhage can be avoided. This method is safe and effective, saves time, and is worth popularizing in clinic.
【作者單位】： 大連醫(yī)科大學(xué)附屬第一醫(yī)院泌尿外科;
【分類號】：R737.11

【相似文獻(xiàn)】

相關(guān)會議論文 前1條

1 邱劍光;高新;;腎周腹膜后隙的筋膜間隙研究[A];第十七屆中國內(nèi)鏡醫(yī)師大會論文集[C];2007年

，

本文編號：2150737