CAJ | 학술논문

目的探讨泌尿外科同侧二次腹腔镜手术可行性,总结经验和体会. 方法行同侧二次腹腔镜手术患者13例.第一次手术路径:经腹膜后4例,经腹9例.第一次手术原因:肾盂输尿管连接处梗阻3例、输尿管结石3例、肾盂结石2例、肾上腺肿瘤2例、肾囊肿2例、多囊肾1例.第二次手术原因:患侧肾脏无功能4例、结石复发3例、肾囊肿复发1例、肾盂输尿管吻合处狭窄1例、同侧肾脏发生肾癌I例、多囊肾再次进展1例、肾上腺肿瘤残留和复发各1例.2次手术间隔6～72个月,平均30个月.第二次手术均取经腹入路,直视下进腹建立气腹,松解肠道粘连后打开侧腹膜及肾周筋膜,先从解剖清晰、粘连轻处按解剖层次,逐步暴露手术部位完成手术,未切除肾脏病例术后缝合肾周筋膜及侧腹膜,恢复解剖关系. 结果第一次手术平均手术时间93 min,平均出血量70ml,平均术后住院时问4.8 d.第二次手术均顺利完成,平均手术时间97 min,平均出血量62 ml,平均术后住院时间5.0 d.第二次手术中均发现不同程度粘连和解剖位置变化,手术难度增加.二次手术后13例随访2～24个月,未发生严重并发症. 结论选择合适病例,在熟练掌握相关技巧后,二次腹腔镜手术可以应用于有同侧泌尿外科腹腔镜手术史患者.
목적 탐토비뇨외과동측이차복강경수술가행성,총결경험화체회. 방법행동측이차복강경수술환자13례.제일차수술로경:경복막후4례,경복9례.제일차수술원인:신우수뇨관련접처경조3례、수뇨관결석3례、신우결석2례、신상선종류2례、신낭종2례、다낭신1례.제이차수술원인:환측신장무공능4례、결석복발3례、신낭종복발1례、신우수뇨관문합처협착1례、동측신장발생신암I례、다낭신재차진전1례、신상선종류잔류화복발각1례.2차수술간격6～72개월,평균30개월.제이차수술균취경복입로,직시하진복건립기복,송해장도점련후타개측복막급신주근막,선종해부청석、점련경처안해부층차,축보폭로수술부위완성수술,미절제신장병례술후봉합신주근막급측복막,회복해부관계. 결과 제일차수술평균수술시간93 min,평균출혈량70ml,평균술후주원시문4.8 d.제이차수술균순리완성,평균수술시간97 min,평균출혈량62 ml,평균술후주원시간5.0 d.제이차수술중균발현불동정도점련화해부위치변화,수술난도증가.이차수술후13례수방2～24개월,미발생엄중병발증. 결론 선택합괄병례,재숙련장악상관기교후,이차복강경수술가이응용우유동측비뇨외과복강경수술사환자.
Objective To evaluate the feasibility and clinical results of laparoseopic reoperation for patients with history of previous ipsilateral urology laparoscopic surgeries. Methods Thirteen patients that underwent second ipsilateral urology laparoscopic surgeries were retrospectively ana-lysed. The reasons for a second operation included nonfunctional kidney after pyeloplasty, ure-terolithotomy or pyelolithotomy in 4 cases, recurrence of urinary calculi in 3 cases, pelviureteric june-tional stenosis after pyeloplasty in 1 case, recurrence of renal cyst in 1 case, recurrence of adrenal tumor in 1 case, residual adrenal tumor in 1 case, progression of polycystic kidney in 1 case and renal carcinoma after laparoscopic surgery for renal cyst in 1 case. Transperitoneal laparoscopie surgeries were performed in all cases and the first trocar was placed with open incision to avoid puncture injury. The adhesion between intestines and retroperitoneal space was dissected to expose the operative field. The lateral peritoneum and perirenal fascia were sutured after surgery in all cases except nephrectomy cases. Results For the first operation, the mean operative time was 93 min, the mean estimated blood loss was 70 ml and the average postoperative hospital stay was 4.8 d. The second operations on the 13 cases were successfully performed with mean operative time of 97 rain, mean estimated blood loss of 62 ml and average postoperative hospital stay of 5.0 d which were not significantly different from the first operation parameters(P＞0.05). During the secondary operations, adhesions and abnor-mal anatomic structure observed increased the difficulty of surgery. All patients after secondary opera-tions were followed up for 2--24 months and no major complication was observed. Conclusion La-paroscopic reoperation on patients with history of ipsilateral urology laparoscopic surgery is feasible in skilled and experienced hands and in properly selected cases.