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目的总结后腹腔镜肾癌根治术并发症的经验。方法我院2002年11月～2006年5月行后腹腔镜下肾癌根治术122例,共发生并发症7例,发生率5.7%。第1例精索静脉损伤,中转开放手术止血,出血量约1000ml,输血800ml。第2例副肾动脉出血,术中仅用超声刀切断,术后20h血压下降至90/60mmHg,再次手术,用4号线结扎副肾动脉,出血约600ml,输血400ml。第3例腔静脉损伤为用直线切割器切割闭合右肾静脉时误将腔静脉切割封闭一半,但未出血。第4例为直线切割器切断肾动脉后残端喷血,又上2个钛夹,出血停止。第5、6例为剪断动脉时误伤肾静脉,1例用Hem-o-lok控制近心端,另1例用10个钛夹纵行夹闭肾静脉止血。第7例为胰尾漏,术后引流液体最多时达300ml,引流液淀粉酶26000U/L。结果腔静脉损伤者术后随访30个月,未见异常;胰尾漏者术后随访1年,肾窝无积液,无胰腺炎;其余5例随访20～40个月均未见异常。结论腹腔镜下并发症主要是大血管损伤,处理的原则是提高气腹压至18～20mmHg,镇静地钛夹夹闭出血点,必要时及时改为开放手术。保持引流管通畅可以有效地治疗胰腺损伤。
Objective To summarize the experience of retroperitoneal laparoscopic radical nephrectomy. Methods 122 cases of retroperitoneal laparoscopic radical nephrectomy in our hospital from November 2002 to May 2006 were retrospectively analyzed. A total of 7 complications occurred in 5.7% of them. The first case of varicocele injury, transit open surgery to stop bleeding, bleeding about 1000ml, 800ml blood transfusion. The second case of renal hemorrhage, intraoperative ultrasound only cut off the knife, 20h after the blood pressure dropped to 90 / 60mmHg, reoperation, with line 4 ligation of the accessory renal artery, bleeding about 600ml, 400ml blood transfusions. The third case of vena cava lesions with a linear cutter to close the right renal vein mistakenly cut the vena cava half closed, but not bleeding. The fourth case of linear cutter cut off the renal artery after the stump spurting, but also on the two titanium clips, bleeding stopped. The fifth and sixth cases were accidental injury of the renal vein when the artery was cut, one case was controlled by Hem-o-lok, and the other one was used to clamp the renal vein to stop the bleeding with 10 titanium clips. The seventh case of pancreatic tail leakage, drainage fluid after up to 300ml, drainage fluid amylase 26000U / L. Results The vena cava lesions were followed up for 30 months and no abnormalities were observed. The patients with pancreatic tail leakage were followed up for 1 year and had no effusion in the kidney and no pancreatitis. The other 5 cases were followed up for 20-40 months. Conclusions The main complications of laparoscopic major vascular injury, the principle of treatment is to increase the pneumoperitoneum pressure to 18 ~ 20mmHg, calm titanium clip clamping bleeding, if necessary, promptly changed to open surgery. Keeping the drainage tube open can effectively treat pancreatic injury.