CAJ | 학술논문

目的介绍自创建立腹膜后腔的IUPU法(Institute of Urology,Peking University的首字母缩写),并探讨其简单性、安全性及实用性. 方法 1996年2月至2006年3月应用IUPU法建立腹膜后腔并实施后腹腔镜下手术1114例.首先于髂嵴上缘2 cm近腋前线处切1 cm小切口,穿刺气腹针入腹膜后腔,注气压力至14 mm Hg(1 mm Hg=0.133 kPa)后引入第1个套管针,引入腹腔镜后以镜身直接做左右往复运动扩张建立腹膜后腔隙.监视下行第2及第3套管针穿刺,进入已建立的腹膜后腔,并引入操作器械以进一步游离扩大腹膜后间隙.1114例手术包括单纯肾切除术54例、根治性肾切除术188例、肾输尿管全长切除术154例、肾上腺切除术344例、肾囊肿去顶术302例、肾部分切除术35例、UPJ成形术37例. 结果 IUPU法建立腹膜后腔时间4.5～14.5(5.4±2.8)min.8例(0.72%)因第1个套管针穿刺致出血改为开放手术,32例(2.87%)第1套管针穿刺进入腹腔,但通过直视下调整腹腔镜进入腹膜后腔仍可建立足够大小的腹膜后间隙,手术顺利完成.无其他脏器损伤. 结论 IUPU法建立腹膜后腔简单、安全、实用,无须特殊器械,熟练掌握后仅需5 min左右,是一种值得在后腹腔镜下操作中常规应用的建立腹膜后间隙的方法.
목적 개소자창건립복막후강적IUPU법(Institute of Urology,Peking University적수자모축사),병탐토기간단성、안전성급실용성. 방법 1996년2월지2006년3월응용IUPU법건립복막후강병실시후복강경하수술1114례.수선우가척상연2 cm근액전선처절1 cm소절구,천자기복침입복막후강,주기압력지14 mm Hg(1 mm Hg=0.133 kPa)후인입제1개투관침,인입복강경후이경신직접주좌우왕복운동확장건립복막후강극.감시하행제2급제3투관침천자,진입이건립적복막후강,병인입조작기계이진일보유리확대복막후간극.1114례수술포괄단순신절제술54례、근치성신절제술188례、신수뇨관전장절제술154례、신상선절제술344례、신낭종거정술302례、신부분절제술35례、UPJ성형술37례. 결과 IUPU법건립복막후강시간4.5～14.5(5.4±2.8)min.8례(0.72%)인제1개투관침천자치출혈개위개방수술,32례(2.87%)제1투관침천자진입복강,단통과직시하조정복강경진입복막후강잉가건립족구대소적복막후간극,수술순리완성.무기타장기손상. 결론 IUPU법건립복막후강간단、안전、실용,무수특수기계,숙련장악후부수5 min좌우,시일충치득재후복강경하조작중상규응용적건립복막후간극적방법.
Objective To assess the safety,efficacy and reliability of IUPU(Abbreviation of Institute of Urology,Peking University)technique in setting up the retroperitoneal cavity for retroperitoneoscopy. Methods From February 1996 to March 2006,more than 1100 retroperitoneoscopic procedures were performed with the IUPU technique in setting up the retroperitoneal cavity,First,at the cross point of the line 2 cm above the iliac crest and the longitudirml line close to the anterior auxiliary line,a 1 cm skin incision was made and the Veress needle was penetrated into the retroperitoneal space(RPS)with a 0°-30° angle to the perpendicular line.The CO2 gas was pumped into the RPS till the pressure increases to 14mmHg and the first port was inserted into the RPS.The laparoscope was then inserted into the RPS through the first port and kept swinging right and left with its tip and trunk tO set up the retroperitoneal cavity.Other 2 ports were put into the RPS at cross points of the sub-costal line and anterior and posterior auxiliary lines under monitor observation.Then other appliances are introduced into the RPS to expand the cavity.More than 1100 procedures had been done with the IUPU technique,including 54 cases of simple nephrectomy (loss of function due to tuberculosis,hydronephrosis and atrophy), 188 radical nephrectomy, 154 ureteronephrectomy, 344 adrenalectomy, 302 renal cyst decortications, 35 partial nephrectomy, 37 pyeloplasty. Results The average time for the IUPU technique was (5.4±2.8)min (range 4. 5 to 14. 5 min) to set up the RPS. Complications included converting to open surgery due to bleeding in 8 cases(8/1114,0. 72%) when the first port was inserted into the RPS and entered into the peritoneal cavity for the first port penetration in 32 cases (32/1114,2. 87%),although the retroperitoneal cavity could be set up successfully by adjusting the laparoscope into the RPS.There was no injury to other viscera. Conclusions The IUPU technique is safe, efficient and reliable in setting up the RPS and no other special instrument is needed. It can be finished within 5 min on skilled hands and is valuable as a routine method to set up the retroperitoneal cavity.