A fast method to identify renal vessels during retroperitoneal laparoscopic nephrectomy
A fast method to identify renal vessels during retroperitoneal laparoscopic nephrectomy
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DOI：
10.1089/end.2008.0028
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发表时间：
2008-08-01
影响因子：
2.7
通讯作者：
Hong, Baofa
中科院分区：
文献类型：
--
作者：
Gao, Jiangping;Guo, Gang;Hong, Baofa
目的：探讨后腹腔镜肾切除术中快速识别肾血管的方法。方法：自2003年10月至2006年6月，共施行后腹膜后腹腔镜肾切除术150例。通过以下五个步骤识别肾动脉：定位、牵拉、隆起、搏动和纤维蛋白。然后用直线切割器或Hem-o-Lok夹切断或结扎肾动脉。肾动脉下方腹侧切开显露肾静脉。对肾静脉的处理与对肾动脉的处理相同。结果：150例手术均顺利完成，且能在短时间内识别出肾血管。平均手术时间90min(45~120min)，平均出血量105mL(10~510mL)。标本重量140~890g，平均494g。所有患者均在3天内给予常规饮食和步行治疗。术后2~4天拔除引流管。无一例中转开腹手术及输血。发生轻微并发症12例(8%)，无严重并发症发生。平均住院时间为6.3天。按照这五个步骤，可以快速、方便地识别出肾血管。结论：后腹腔镜肾切除术可通过定位、牵拉、隆起、搏动、纤维蛋白等5个步骤快速识别肾血管。实践证明，该方法是一种适合临床应用的有效方法。
Purpose: To evaluate a fast method to identify renal vessels during retroperitoneal laparoscopic nephrectomy.Methods: One hundred fifty retroperitoneal laparoscopic nephrectomies were performed from October 2003 to June 2006. The renal arteries were identified by following five steps: location, pulling, apophysis, pulsation, and fibrin. Then the renal arteries were severed or ligatured with a linear cutter or Hem-o-lok clips. The renal veins were exposed by dissecting toward the abdominal side under the renal arteries. The management for the renal veins was the same with that of the renal arteries. The fast method to identify the renal vessels during retroperitoneal laparoscopic nephrectomy were evaluated.Results: All 150 procedures were successfully completed, and the renal vessels could be identified in short time. The average time to operation was 90 min (range 45-120 min) with average blood loss of 105 mL (range 10-510 mL). The average specimen weight was 494 g (range 140-890 g). Intake of usual diet and walking were allowed within 3 days for all patients. Drains were removed within 2-4 postoperative days. No patient was converted into an open surgery and blood transfusion. Minor complications were found in 12 cases (8%), and no severe complication occurred in any of the 150 cases. The median time to hospitalization was 6.3 days. Following the five steps, the renal vessels could be identified quickly and easily. The duration of the operations, the risk of conversion to the open surgery, and the vessel injury were decreased.Conclusions: Renal vessels could be identified quickly by the following the five steps during retroperitoneal laparoscopic nephrectomy: location, pulling, apophysis, pulsation, and fibrin. It proved to be a useful method suitable for clinic application.