经肾下极途径处理肾蒂在后腹腔镜老年患者肾切除中的应用.docVIP

经肾下极途径处理肾蒂在后腹腔镜老年患者肾切除中的应用 作者：王伟刚 安 伟 傅耀文 高宝山 作者单位：(吉林大学第一医院泌尿系统疾病诊治中心，吉林 长春 130021) 【摘要】 目的 经肾下极途径处理肾蒂、肾窦在老年患者后腹腔镜肾切除中的经验及临床价值。方法 将42例老年肾切除患者分为2组：后腹腔镜肾切除组(n=22例);常规手术对照组(n=20例)。对比两组手术时间、术中出血量、住院天数。结果 后腹腔镜肾切除组22例手术全部成功，平均手术时间(92±15)min，与对照组比较无显著差异。出血量平均(35±12)ml，术后住院(6.2±1.5)d，与对照组相比有显著差异。结论 经肾下极途径在后腹腔镜中处理肾动静脉血管及肾窦，增加了后腹腔镜中处理肾血管及肾窦的手术立体感，安全可靠。 【关键词】 腹腔镜;肾切除;肾下极 Use of the way to manage the hilus renalis and renal sinus from the inferior pole of kidney in retroperitoneal laparoscopic operation 　　WANG WeiGang, AN Wei, FU YaoWen, et al. 　　Center of Diagnose and Treatment on Urology System Disease, the First Hospital of Jilin University, Changchun 130021, Jilin, China 　　【Abstract】 Objective To introduce the experience and clinical value of the way to manage the hilus renalis and renal sinus from the inferior pole of kidney in retroperitoneal laparoscopic operation. Methods A series of 42 consecutive patients were randomly divided into the retroperitoneal laparoscopic nephrectomy (n=22) and control (n=20) groups. Then the operation time, the blood loss volume, postoperative hospital stay time were compared. Results All the operations were successful in 22 cases of patients. The median operation time was (92±15) min. The median blood loss volume was (35±12) ml. The median postoperative hospital stay time was (6.2±1.5) d. There were obviously different in blood loss volume and postoperative hospital stay between the two groups. Conclusions The way to manage the hilus renalis and renal sinus from the inferior pole of kidney in retroperitoneal laparoscopic operation is safe and reliable. At the same time, it increases the stereoscopy of operation. 　　【Key words】 Laparoscope; Nephretomy; Inferior pole of kidney 　　后腹腔镜肾切除术是目前治疗功能丧失肾疾病的标准手术方式，但由于后腹腔镜操作空间小，无显著解剖标识，立体感差，处理肾蒂、肾窦部位有一定难度。尤其是老年患者，血管弹性差，分离过程中容易出血。我科自2007年8月至2009年3月在老年患者行后腹腔镜经肾下极途径处理肾蒂及肾窦，完成无功能肾后腹腔镜肾切除术22例，取得满意疗效。 　　1 资料与方法 　　1.1 临床资料 42例老年患者均有无功能肾，男性25例，女性17例，年龄53～72岁，平均6