后腹腔镜根治性肾切除术中的筋膜间隙层面解剖研究
发布时间：2018-07-28 15:36
【摘要】：通过对腹膜后腔筋膜间隙层面解剖的研究总结,在后腹腔镜根治性肾切除术中寻找安全正确的解剖层面,进行无血化解剖性手术操作,改进游离、切除肾脏的手术技巧。2016年3月~2017年3月收治61例局限性肾癌患者,其中左侧33例,右侧28例;肿瘤直径3.4cm~7.5cm,平均5.6cm。通过寻找显露肾旁前间隙、腰肌前间隙、肾筋膜前叶肾前融合筋膜间隙等无血管平面,实施无血化解剖性肾切除手术。61例手术均获成功,无中转开放手术。手术时间43min~98min,平均61min;出血量30ml~150ml,平均75ml;术后4d~8d出院。7例发生腹膜破裂,5例发生肾上腺腺体轻微撕裂,少量出血,无输血,无其他严重并发症发生。根据腹膜后腔筋膜间隙层面解剖的特点,通过辨认及分离肾旁前间隙、腰肌前间隙、肾筋膜前叶肾前融合筋膜间隙等无血管层面,可充分显露手术空间,在直视下辨别毗邻关系,可无血化解剖性实施手术,术中出血少,避免周围毗邻脏器损伤及大出血等并发症。该方法安全有效、节省时间,值得在临床推广应用。
[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.
【作者单位】： 大连医科大学附属第一医院泌尿外科;
【分类号】：R737.11
本文编号：2150737
[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.
【作者单位】： 大连医科大学附属第一医院泌尿外科;
【分类号】：R737.11
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1 邱剑光;高新;;肾周腹膜后隙的筋膜间隙研究[A];第十七届中国内镜医师大会论文集[C];2007年
，本文编号：2150737
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