腹腔镜在泌尿外科中的应用.pptVIP

腹腔镜在泌尿外科中的应用 北京大学泌尿外科研究所 周 利 群 腹腔镜发展史(1) 1901 KELLING reported first laparoscopy in a dog 1910 JACOBAEUS reported first laparoscopy in man 1911 JACOBAEUS reported first series of 115 laparoscopies in man. 1938 VERESS introduced spring loaded needle 1958 ZOECKLER reported 1000 cases with 0.3% mortality 1964 KURT SEMM introduced Automatic Insufflation Device 腹腔镜发展史(2) 1980 SEMM reported wide range of gynaecological operations SEMM described intra and extra corporeal knot tying techniques. 1987 MOURET described first laparoscopic cholecystectomy 腹腔镜发展史(3) 1976 CORTESI identified undescended testes 1979 WICKHAM Ureterolithotomy 1991 SCHUESSLER Staging pelvic lympha-denectomy for prostate cancer 1991 CLAYMAN Simple nephrectomy 1991 CLAYMAN Radical Nephrectomy 腹腔镜发展史(4) 1991 SCHEUSSLER Bladder neck suspension 1991 DONOVAN Varicocele ligation 1991 WINFIELD Renal Cyst exploration 1992 WATERHOUSE Retroperitoneal lymphadenectomy for testicular cancer 1992 KAVOUSSI Ureterolysis 腹腔镜发展史(5) 1992 KOZMINSKI Laparoscopic ileal conduit 1992 SCHUESSLER Laparoscopic radical prostatectomy 1992 WINFIELD Partial nephrectomy 1992 LOWE Segmental Cystectomy 1992 DAS Bladder diverticulectomy 1992 JORDAN Complete management of undescended testicle 腹腔镜发展史(6) 1992 PARRA Simple cystectomy for retained bladder 1993 TOWNELL Vaginal retrieval of malignant kidney 1994 TOWNELL Radical cystectomy and prostato-urethrectomy with ileal conduit 2000 Series on trans and retro peritoneal laparoscopic pyeloplasty by several authors 2000 VALLANCIEN Large series of laparoscopic radical prostatectomies 腹腔镜手术的优点 损伤小：切口小、出血少。 手术效果肯定，可达开放手术效果。 术后合并症少。 恢复快，住院时间短。 微创外科的重要组成部分 腹腔镜手术的缺点 器械较贵。 需要全麻。 技术精细，经验要求高。 手术时间较长。 有并发症时需改为开放手术 腹腔镜泌尿外科手术的适应症 肾囊肿去顶术 静锁静脉高位结扎术 腹腔内隐皋探查术 盆腔淋巴结活检术 肾上腺肿瘤切除术 肾切除术 肾癌根治术 输尿管切开取石术 肾盂输尿管癌肾输尿管全长切除术 腹膜后淋巴结清扫术 根治性前列腺切除术 膀胱颈悬吊术 肾盂成型术 根治性膀胱全切及回肠膀胱术 腹腔镜泌尿外科手术的禁忌症 绝对禁忌症： 严重心肺疾患不能耐受全麻 未纠正的凝血功能障碍 没有控制的感染性疾病 腹部广泛粘连 相对禁忌症： 腹部手术史 过度肥