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目的探讨后腹腔镜手术治疗肾上腺及上尿路疾病的临床效果及手术技巧。方法采用后腹腔镜手术治疗肾上腺及上尿路疾病136例,其中肾囊肿去顶减压术68例,肾上腺手术15例(原发性醛固酮增多症4例,嗜铬细胞瘤4例,皮质醇腺瘤2例,神经纤维瘤2例,无功能皮脂腺瘤2例,皮质增生1例),单纯性肾切除术15例,肾癌根治性肾切除术8例,肾盂癌肾输尿管全切术5例,肾盂输尿管成型术3例,输尿管切开取石术12例。结果 134例获得成功,转开放手术5例,无严重并发症发生,疗效满意。结论后腹腔镜手术具有创伤小、出血少、疼痛轻、恢复快等优点,清理腹膜后脂肪为手术提供了较好的视野及空间,通过腰大肌及膈肌脚寻找输尿管及肾动脉方法可靠。
Objective To investigate the clinical effects and surgical techniques of retroperitoneal laparoscopic surgery for adrenal and upper urinary tract diseases. Methods One hundred and sixty-six patients with adrenal and upper urinary tract diseases were treated with retroperitoneal laparoscopic surgery, including 68 cases of renal cyst debridement and decompression, 15 cases of adrenal surgery (4 cases of primary aldosteronism, 4 cases of pheochromocytoma, Adenoma in 2 cases, neurofibroma in 2 cases, non-functioning sebaceous adenoma in 2 cases, cortical hyperplasia in 1 case), simple nephrectomy in 15 cases, radical nephrectomy in 8 cases, renal pelvis and renal pelvis excision in 5 cases Cases, ureteropexy in 3 cases, ureterolithotomy in 12 cases. Results 134 cases were successful, open surgery in 5 cases, no serious complications, the effect is satisfactory. Conclusions Retroperitoneal laparoscopic surgery has the advantages of less trauma, less bleeding, less pain, quicker recovery and so on. Clearing the retroperitoneal fat provides a good field of vision and space for surgery. It is reliable to look for the ureter and renal artery through the psoas muscle and phrenic muscle.