后腹腔镜下肾切除术中肾血管的处理方法探讨

摘要

目的 探讨后腹腔镜下肾切除术中左右肾血管不同的处理方法及临床价值.方法 回顾性分析2005年3月至2011年12月行后腹腔镜下肾切除术的64例患者的病例资料及手术视频,总结术中处理肾血管的经验.术中以腰肌前间隙内侧弓状韧带为解剖标志寻找右肾蒂,小心处理右肾静脉防止撕裂下腔静脉；在腰肌前间隙腹主动脉旁脂肪前内寻找左肾蒂,避免损伤或漏扎左肾血管属支.结果 64例手术均获成功,无中转开放手术及输血病例,术后未出现严重并发症.结论 熟悉肾血管的解剖特征,采用不同的方法分别处理左右肾血管,有利于提高后腹腔镜下肾切除术的安全性.%Objective To study the treatment for the bilateral renal vessels during retroperitoneoscopic nephrectomyand its clinical value. Methods The surgical video and clinical data of 64 cases undergoing retroperitoneoscopic nephrectomy from march 2005 to december 2011 were retrospectively analyzed. The renal pedicle was found located at the psoas and the medial arcuate ligament of the diaphragm for anatomic landmark before the gap of the psoas. Careful handling of the right renal vein to prevent tearing of the inferior vena cava. The left renal pedicle was found located at the abdominal aorta fatty front inner side before the gap of the psoas. To avoid tearing and omission of left renal vascular branches. Results All the operations were performed successfully with no conversion to open surgery, no blood transfusion and no severe complications. Conclusion Be familiar with the anatomical features of renal vessels and use different methods to handle the bilateral renal vessels during retroperitoneoscopie nephrectomy will help to improve the safety of the surgery.