后腹腔镜肾癌根治术并发症7例总结

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1000 ml,输血800 ml.第2例副肾动脉出血,术中仅用超声刀切断,术后20 h血压下降至90/60 mm Hg,再次手术,用4号线结扎副肾动脉,出血约600 ml,输血400 ml.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300 ml,引流液淀粉酶26 000 U/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18～20 mm Hg,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.

Complications During Retroperitoneal Laparoscopic Nephrectomy: A Report of 7 Cases

Objective To summarize the complications of retroperitoneal laparoscopic nephrectomy. Methods From November 2002 to May 2006, 122 patients with renal carcinoma underwent retroperitoneal laparoscopic nephrectomy. Complications occurred in 7 patients,and the morbidity was 5.7%. One case of injury to vena spermatica converted to open surgery, the blood loss was 1000 ml with blood transfusion 800 ml, One postoperation hemorrhage of accessory renal artery which was cut off only by harmonic scalpel,leading to blood pressure decrease to 90/60 mm Hg,and a reoperation was performed and the blood loss was 600 ml with blood transfusion 400 ml. Injury of inferior vena cava by linear cutter stapler in one case, and there was no blood loss, Hemorrhage of renal artery stump after linear cutter stapler in one case and it was controlled by titanium cllp, Injury of renal vein occurred in two cases and all were controlled by Hem-o-lok or titanium clip, Injury of tall of pancreas in one case and a drainage tube was placed. Results A patient with vena cava injury was followed for 30 months and no abnormality was noted. A patient with pancreas injury was followed for 1 year and nothing remarkable was noted. The other 5 cases was followed for 20 -40 months, and they remained in good health. Conclusion The major complication for retroperitoneal laparoscopic surgery is injury to large blood vessels, the principle of treatment is to elevate the pressure of pneumoperitoneum up to 18 - 20 mm Hg and clip the blutpunkte or convert to open surgery promptly. A good drainage is necessary for the treatment of injury of pancreas.