腹腔镜技术治疗复杂性肾囊肿的并发症特点分析
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摘要
目的:回顾分析腹腔镜技术治疗复杂性肾囊肿并发症的原因,探讨其治疗方法及预防措施。方法:选取2013年3月-2017年3月于日照市中心医院接受腹腔镜技术治疗的47例复杂性肾囊肿患者的临床资料,总结分析术后并发症发生情况,探讨原因,提出预防措施。结果:47例患者中,45例顺利完成腹腔镜手术治疗,2例中转开放手术。术中并发大出血1例;术中快速冷冻病理报告错误1例;术后并发感染1例;并发漏尿5例。术后复查发现患者中存在残留囊肿者7例。结论:对于肾囊肿与周围肾血管、肾盂间关系的误判是引起手术并发症的主要原因,而术前完善影像学检查,术中采取相应措施能够减少手术并发症的发生。
Objective:To analyze the causes of complications during laparoscopic treatment of complex renal cyst,and investigate treatment methods and precautions.Methods:The clinical data of 47 patients receiving laparoscopic operation in Rizhao Central Hospital from March 2013 to March 2017 were retrospectively analyzed. The causes of complications and the improvement measures were studied.Results: Forty-five cases of laparoscopic operation were performed successfully. Two cases were intraoperatively converted to open surgery. The main complications included hemorrhea(1 case),error of intraoperative frozen section analysis(1 case),postoperative infection(1 case),leakage of urine(5 cases)and postoperative cyst residue(7 cases).Conclusions:Misjudgement of the relationship between renal cyst and renal vessels and renal pelvis is the main cause of complications. The preoperative preparation and improved surgical skills can reduce the occurrence of surgical complications.
Objective:To analyze the causes of complications during laparoscopic treatment of complex renal cyst,and investigate treatment methods and precautions.Methods:The clinical data of 47 patients receiving laparoscopic operation in Rizhao Central Hospital from March 2013 to March 2017 were retrospectively analyzed. The causes of complications and the improvement measures were studied.Results: Forty-five cases of laparoscopic operation were performed successfully. Two cases were intraoperatively converted to open surgery. The main complications included hemorrhea(1 case),error of intraoperative frozen section analysis(1 case),postoperative infection(1 case),leakage of urine(5 cases)and postoperative cyst residue(7 cases).Conclusions:Misjudgement of the relationship between renal cyst and renal vessels and renal pelvis is the main cause of complications. The preoperative preparation and improved surgical skills can reduce the occurrence of surgical complications.
引文
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[6]陈羽,黄小萍,丘少鹏.预防后腹腔镜治疗复杂肾囊性疾病术后尿漏的经验总结——附59例报告.新医学,2009,40(10):654-655,660.
[7]刘茁,田晓军,马潞林,等.后腹腔镜下肾囊肿去顶术治疗肾盂旁囊肿的临床分析.北京大学学报(医学版),2018,50(5):941-944.
[8]龚道静,周天贵,龙兵,等.后腹腔镜下肾囊肿去顶术后漏尿1例.微创泌尿外科杂志,2013,2(6):406-407.
[9]邹岷,李伟,肖民辉,等.输尿管镜在肾囊性病变治疗中的临床应用研究.微创泌尿外科杂志,2014,3(1):37-40.
[10] KRISHNAN B,LECHAGO J,AYALA G,et al.Intraoperative consultation for renal lesions. Implications and diagnostic pitfalls in 324 cases. Am J Clin Pathol,2003,120(4):528-535.
[11]王文营,郭宇文,杨培谦,等.术中冷冻病理在复杂性肾囊肿治疗决策中的价值探讨.临床泌尿外科杂志,2016,31(8):727-729.
[12] ATUG F,BURGESS SV,RUIZ-DEYA G,et al.Long-term durability of laparoscopic decortication of symptomatic renal cysts. Urology,2006,68(2):272-275.
[13] GUPTA NP,GOEL R,HEMAL AK,et al. Retroperitoneoscopic decortication of symptomatic renal cysts. J Endourol,2005,19(7):831-833.
[14]李志清,王文刚,陈新忠,等.经腹与后腹腔途径腹腔镜治疗肾囊肿.微创泌尿外科杂志,2015,4(4):215-217.
[2] OH TH,SEO IY. The role of Bosniak classification in malignant tumor diagnosis:A single institution experience. Investig Clin Urol,2016,57(2):100-105.
[3] ELLIMOOTTIL C,GRECO KA,HART S,et al.New modalities for evaluation and surveillance of complex renal cysts. J Urol,2014,192(6):1604-1611.
[4] SIMMS RJ,ONG AC. How simple are'simple renal cysts'? Nephrol Dial Transplant,2014,29 Suppl 4:106-112.
[5]陈宇,吴宁.肾囊性肿物的Bosniak分级及相关影像诊断.肿瘤学杂志,2011,17(4):298-300.
[6]陈羽,黄小萍,丘少鹏.预防后腹腔镜治疗复杂肾囊性疾病术后尿漏的经验总结——附59例报告.新医学,2009,40(10):654-655,660.
[7]刘茁,田晓军,马潞林,等.后腹腔镜下肾囊肿去顶术治疗肾盂旁囊肿的临床分析.北京大学学报(医学版),2018,50(5):941-944.
[8]龚道静,周天贵,龙兵,等.后腹腔镜下肾囊肿去顶术后漏尿1例.微创泌尿外科杂志,2013,2(6):406-407.
[9]邹岷,李伟,肖民辉,等.输尿管镜在肾囊性病变治疗中的临床应用研究.微创泌尿外科杂志,2014,3(1):37-40.
[10] KRISHNAN B,LECHAGO J,AYALA G,et al.Intraoperative consultation for renal lesions. Implications and diagnostic pitfalls in 324 cases. Am J Clin Pathol,2003,120(4):528-535.
[11]王文营,郭宇文,杨培谦,等.术中冷冻病理在复杂性肾囊肿治疗决策中的价值探讨.临床泌尿外科杂志,2016,31(8):727-729.
[12] ATUG F,BURGESS SV,RUIZ-DEYA G,et al.Long-term durability of laparoscopic decortication of symptomatic renal cysts. Urology,2006,68(2):272-275.
[13] GUPTA NP,GOEL R,HEMAL AK,et al. Retroperitoneoscopic decortication of symptomatic renal cysts. J Endourol,2005,19(7):831-833.
[14]李志清,王文刚,陈新忠,等.经腹与后腹腔途径腹腔镜治疗肾囊肿.微创泌尿外科杂志,2015,4(4):215-217.