泌尿外科腹腔镜手术改行开放手术的原因浅析

目的 分析泌尿外科腹腔镜手术改行开放手术的原因。方法 对165例泌尿外科腹腔镜手术患者的临床资料进行分析，其中26例（16％）改形开放手术。结果 26例改行开放手术原因；未找到病灶8例，气腹或腹膜后充气不满意5例，粘连分离困难5例，出血4例，损伤周围脏器2例，设备故障2例。不同疾病改行开放手术的比例分别为肾上腺手术42％（8／19），肾切除术25％（2／8），肾囊肿去顶术18％（11／61），前列腺癌盆腔淋巴结活检术17％（1／6），精索静脉结扎术3％（2／60），隐睾探查术19％（2／11）。结论 掌握适应证和手术入路、熟悉操作技术、改进设备是提高泌尿外科腹腔镜手术成功率的关键。

Analysis of the causes of laparoscopic converted to open surgery in urology

Objective To analyze the causes of laparoscopic converted to open surgery in urology. Methods The study included 165 patients undergoing urologic laparoscopic surgery in our institute. A total of 26 patients(16%) converted to open surgery during the procedure. Results The primary causes of conversion to open surgery were missed target in 8 patients, discontent of intraperitoneal or retroperitoneal insufflation in 5, adherence in 5,hemorrhage in 4,injury of organ in 2 and malfunction of instruments in 2 cases. Different laparoscopic procedures had different proportion of conversion to open surgery.In laparoscopic adrenalectomy 42% of patients converted to open surgery (8/19), 25% in nephrectomy(2/8), 18% in renal cyst excision(11/61), 17% in pelvic lymphadenectomy of prostatic cancer(1/6),3% in varico- celectomy (2/60) and 19% in orchiectomy(2/11). Conclusions Selection of proper indication and laparoscopic approach, improvement of skill and adequate instruments are essential for urologic laparoscopy.