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PostPosted: Fri 10:02, 25 Mar 2011    Post subject: moncler outlet 腹腔镜&#324

腹腔镜结合超声刀治疗肾囊肿
发,亦可多发,肾囊肿体积小,无肾实质或肾盂肾盏受压,无感染、恶变,无腰背部疼痛、血尿、高血压者,一般不予治疗,[link widoczny dla zalogowanych],采用B超定期检查,随访观察。目前认为直径大于4cm肾囊肿,肾实质,肾盂肾盏受压,或肾下极囊肿压迫输尿管引起梗阻者或患者症状明显或肾囊肿合并感染者,可考虑肾囊肿去顶减压术治疗。介入超声治疗在我国已经广泛开展,采用经皮穿刺抽取囊液或穿刺囊肿注入硬化剂(如无水乙醇、碘苯酯、四环素、磷酸铋等)虽有近期的短暂疗效,但复发率高,还可能使囊肿增大,反复穿刺易致感染,诱发癌变可能。本院有3例患者在外院行囊肿穿刺抽液后6~12个月复发,入本院时肾囊肿大小均超过了穿刺治疗前。传统的开放性肾囊肿去顶减压术虽疗效确切,但损伤多,痛苦大,恢复也慢J。腹腔镜下肾囊肿去顶减压术创伤小,痛苦小,[link widoczny dla zalogowanych],手术效果确定。90年代以来,国内腹腔镜在泌尿外科领域广泛开展目前公认为肾囊肿是腹腔镜最佳适应手术、腹腔镜规范化治疗的病种,[link widoczny dla zalogowanych],采用腹腔镜技术做肾囊肿去顶减压术有经腹腔和经腹膜后两种途径。有研究将两种手术方式进行比较,认为腹腔镜经腹腔后途径手术创伤小,术后恢复快,患者痛苦小_2]。腹腔后途径对手术者要求高,需要熟练的操作技能,同时注意严格掌握手术适应证J。通过与开放手术相比手术时间、住院时间明显减少,并有统计学上意义,同时也降低了住院费用减少了并发症。通过临床应用体会到经腹腔后腹腔镜结合超声刀治疗肾囊肿的优势:(1)超声刀是以超声频率55000HZ进行机械震荡,达到使组织先被凝固,融合后再被切开的效果。超声刀振荡产热少,组织损伤小,不会传导损伤周围组织,其能量向周围传播一般不超过500/anJ。超声刀可同时用于分离及切割,并且凝血和切割可一次完成,减少了频繁更换手术器械,简化了手术步骤,提高了手术效率。(2)腹膜后间隙相对狭小,超声刀在分离切割时仅产生一定的水汽,而不形成烟雾,分离切割处仅少许焦痂,使得手术视野更清晰,操作的准确性增加。(3)超声刀无电流通过人体,使手术更安全,[link widoczny dla zalogowanych],减少了并发症。虽然超声刀对于肾囊肿囊壁切割不如电刀快,但有其止血可靠,如能正确使用超声刀可以凝固直径3mln甚至更粗的血管_5],[link widoczny dla zalogowanych],术中出血少,术后无继发出血。因此本文认为经腹膜后腹腔镜结合超声刀治疗肾囊肿更加精确、安全和可靠、术后恢复快、住院时间短,是目前治疗肾囊肿的首选方法。
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