CAJ | 학술논문

目的：探讨后腹腔镜上尿路手术致腹膜破裂的原因及处理方法。方法对2010年2月-2013年10月收治并行后腹腔镜上尿路手术致腹膜破裂14例的临床资料进行回顾性分析。结果本组行根治性肾切除术5例，肾上腺肿瘤切除术3例，单纯肾切除术、肾部分切除术、肾输尿管全长切除术各2例。腹膜破裂的时间分别为切开侧锥筋膜时3例，建立后腹腔间隙、盲穿腹侧穿刺套管、分离肾脏腹侧粘连处腹膜、分离肾上腺腹侧、器械插入误伤腹膜各2例，清理腹膜外脂肪时损伤腹膜1例。通过Hem-o-lok夹直接夹闭(9例)、腹腔套管排气(5例)、缝合(4例)、手助腹腔镜(1例)等方法处理，恢复腹膜后手术空间，均顺利完成手术。结论掌握好处理腹膜破裂的技巧并及时处理，可减少手术时间，避免并发症的发生，有利于顺利完成手术。
목적：탐토후복강경상뇨로수술치복막파렬적원인급처리방법。방법대2010년2월-2013년10월수치병행후복강경상뇨로수술치복막파렬14례적림상자료진행회고성분석。결과본조행근치성신절제술5례，신상선종류절제술3례，단순신절제술、신부분절제술、신수뇨관전장절제술각2례。복막파렬적시간분별위절개측추근막시3례，건립후복강간극、맹천복측천자투관、분리신장복측점련처복막、분리신상선복측、기계삽입오상복막각2례，청리복막외지방시손상복막1례。통과Hem-o-lok협직접협폐(9례)、복강투관배기(5례)、봉합(4례)、수조복강경(1례)등방법처리，회복복막후수술공간，균순리완성수술。결론장악호처리복막파렬적기교병급시처리，가감소수술시간，피면병발증적발생，유리우순리완성수술。
Objective To investigate the reasons and treatments of peritoneal rupture in upper urinary tract surgery by retroperitoneal laparoscopy. Methods Fourteen patients had peritoneal rupture in upper urinary tract surgery by retroper-itoneal laparoscopy from February 2010 to October 2013, and their clinical data was retrospectively analyzed. Results Of fourteen patients, five patients underwent radical nephrectomy, three patients underwent excision of adrenal tumor, two pa-tients underwent simple nephrectomy, two patients underwent partial nephrectomy, and two patients underwent nephroureterec-tomy;Peritoneal rupture occurred in the time of slitting side of the cone fascia in three cases, cleaning up extraperitoneal fat in one patient, and two cases each in the time of establishing retroperitoneal space, blind abdominal puncture cannula operation, harming peritoneal with devices, dissociating peritoneal adhesions at the ventral kidney damage and dissociating adrenal ven-tral. The treatments for peritoneal rupture were performed to restore the operation space, such as direct closuring with Hem-o-lok ( nine patients) , discharging gas from abdomen ( five patients) , suturing gap ( four patients) , and turning to hand-assis-ted laparoscopy ( one patient) . And all patients were completed the surgeries successfully. Conclusion Marstering the treat-ment skills of peritoneal rupture and dealing with it quickly may reduce operation time, avoid complications and contribute to completing surgery successfully.