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目的:研究肾门部解剖,提高后腹腔镜肾根治性切除术中肾动静脉分离技巧。方法:2007年6月~2011年12月开展腹腔镜下肾癌根治术128例,反复观看手术录像,观察肾门部解剖结构,总结出四步法分离肾动静脉。结果:按四步法分离肾动静脉,126例顺利快速分离、结扎肾血管。因汇入肾静脉的腰静脉撕裂中转开放手术2例。腹膜损伤6例,用hem-o-lok夹闭。胰腺尾部损伤1例,引流管引流16天痊愈。手术时间(146±52)min,失血量中位值150(100~1 500)ml,拔管时间中位值3(2~16)d,术后平均住院时间(8.4±2.6)d。结论:肾血管的分离是手术成功的关键,也是难点。应用四步法分离肾动静脉,对初期开展后腹腔镜肾癌根治术的医师有一定指导意义。
Objective: To study the anatomy of the renal portal and to improve the technique of renal artery and vein separation during radical laparoscopic radical nephrectomy. Methods: From June 2007 to December 2011, 128 patients undergoing laparoscopic radical nephrectomy were performed. Surgical video recording was performed repeatedly to observe the anatomy of the renal portal. The four-step method was used to separate the renal artery and vein. Results: According to the four-step method, the renal artery and vein were separated and 126 cases were rapidly and rapidly separated and the renal vessels were ligated. Renal vein into the renal vein due to open transfer surgery in 2 cases. Peritoneal injury in 6 cases, with hem-o-lok clamp. 1 case of pancreatic tail injury, drainage tube drainage 16 days cure. The median time of operation was 146 ± 52 min, blood loss was 150 (100-1 500) ml, extubation time was 3 (2-16) days, and average postoperative hospital stay was (8.4 ± 2.6) days. Conclusion: The separation of renal vessels is the key to successful operation, but also difficult. Application of four-step separation of renal artery and vein, the initial conduct of laparoscopic radical nephrectomy physicians have some guidance.