![泌尿外科腹腔镜手术疑难病例解析](https://wfqqreader-1252317822.image.myqcloud.com/cover/434/33743434/b_33743434.jpg)
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三、手术方法
1.全身麻醉,气管插管,麻醉成功后,导尿,左侧卧位,常规消毒铺巾。
2.右侧平脐腹直肌旁切开皮肤约1cm,穿刺置气腹成功后(压力15mmHg),进10mm Trocar及腹腔镜,监视下分别于右腋前线平脐、锁骨中线肋缘下、腋中线脐上4cm、置入12mm、5mm、5mm Trocar,置入相应腹腔镜手术器械。
3.在肾周筋膜外切除右侧肾脏(图1-5-4~图1-5-13)。
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-4_6666.jpg?sign=1739592144-fYghzws3Ej6CXnIrOfjaGXVkzxEC1qct-0-37f49c6edadca176bb99a18257be5a06)
图1-5-4 打开侧腹膜
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-5_6667.jpg?sign=1739592144-IOx9OYqm7TdR39qMAbh5V2Q7p6PBll1D-0-bffd9163ae073630fdfb3eec04e8b078)
图1-5-5 推开十二指肠
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-6_6669.jpg?sign=1739592144-JXi7RK1TDd0ZTovl35p2NbUIkUMdQr8a-0-67489821d01c6e7e66aeb8888b166023)
图1-5-6 打开下腔静脉鞘
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-7_6670.jpg?sign=1739592144-mROR18ULZVoMbxViOAMFCbTPyyzibYHn-0-b1307a50dc4ae8d21605a9099f94223f)
图1-5-7 游离肾门动静脉
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-8_6672.jpg?sign=1739592144-erh8A9FSQsyArYTiHulYSwATgb26MqyH-0-635b92f3097a9b39f223625817432f07)
图1-5-8 夹闭动静脉
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-9_6673.jpg?sign=1739592144-IYYhV7kRSNELUpSGRz2wOqfihaniQGmu-0-8c0d0cbedb9fb9b2c3f8af2f243738e9)
图1-5-9 离断动静脉
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-10_6675.jpg?sign=1739592144-YcizFx83iKLWPqZf64YUoUK4KNk8ccEX-0-e884dded7faf0dad1d9c2ad0f5afbf43)
图1-5-10 游离肾脏上极
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-11_6676.jpg?sign=1739592144-PVBTupceKYRoRHG7e61dnSDTP0x8kiLn-0-38e657155ae5566eccfbd3edc635d8ed)
图1-5-11 游离肾脏下极
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-12_6678.jpg?sign=1739592144-Vpvt4MRdUrGfJmMpPrRGoAIDJwlZrc3B-0-5859faad8e3062011d8317e2fb0cdecc)
图1-5-12 游离输尿管中上段
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-13_6679.jpg?sign=1739592144-JXp4QDTqwDtA6BjhCB476eAYLMgRrLd2-0-6f597fa174c4f55d484e97f818e0f4c1)
图1-5-13 游离肾脏背侧面
4.切除下段输尿管至壁段(图1-5-14~图1-5-24)。
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-14_6681.jpg?sign=1739592144-O6CGPUILwYZOHEnpF16nHQzyFDr1mN2X-0-a0caba550cfbb953a7932824fff99f14)
图1-5-14 下腹部加一操作孔
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-15_6682.jpg?sign=1739592144-Xv2J6QvEA0atsc67FbKedXgSTFFGXg5O-0-e5b0317dd13a1e82af887bf84cbcad60)
图1-5-15 游离回盲部及部分升结肠
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-16_6684.jpg?sign=1739592144-aNdSBFtZ8KWQ2Lg0KboIx1UuPpv9gH0W-0-9ed1e5f517776783084eb45380cf6397)
图1-5-16 暴露下段输尿管及髂血管
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-17_6685.jpg?sign=1739592144-1i5aDZLSkWIHU5HHfkmU6VAU1Gk7AjEt-0-82a6f2b9187213d676ac91aa91793ee3)
图1-5-17 右侧髂内血管
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-18_6687.jpg?sign=1739592144-tgsK1pVrk8IZxZnN8ECoEdSDP2oJG9Gk-0-9aa847a8578b3ba3a056eb3a2a98bf22)
图1-5-18 沿着髂内血管游离
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-19_6688.jpg?sign=1739592144-8DV7XFINIQCvn6Oept0O5JxfYOirCNwU-0-86b865119d410759d95668230a8132d6)
图1-5-19 完全暴露髂内血管
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-20_6690.jpg?sign=1739592144-NSkiyjCbQm49UbUqRU2yH2ezmoy9Kpva-0-28ec48985edbb4e493bc38e771453744)
图1-5-20 移植肾动脉与髂内血管吻合处
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-21_6691.jpg?sign=1739592144-TRLshaDMhzKzQ49Oq6gPMWyzpNwHT4N0-0-5a8204bce0231cc1620fe7a949895a9c)
图1-5-21 输尿管肿瘤处
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-22_6693.jpg?sign=1739592144-VhBZ019sKhy2eStpp3b9Eort8hLVHimp-0-f5064f6f0d4fec6ebba0375704832565)
图1-5-22 沿着输尿管向下游离
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-23_6694.jpg?sign=1739592144-3eU9GOrAVF20O2HtlfRA7MqV8d1fmcvs-0-a60d9acd28844b66e6425a0f77769ea6)
图1-5-23 游离输尿管壁段
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-24_6696.jpg?sign=1739592144-W31yV1GxdUSZ1mY0YPCsxBX2Cq4FFprE-0-d5d9e04cd2e18d099c4e77181cc44f82)
图1-5-24 壁段在最低处离断输尿管
5.取出标本,放置引流管(图1-5-25~图1-5-28)。
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-25_6697.jpg?sign=1739592144-c9DKWEztRwmG44XLJG4pRuATTUOT4NMD-0-1ad99ddb6cc949508faa6a0d59a1a2dd)
图1-5-25 盆腔放置引流管
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-26_6699.jpg?sign=1739592144-MsT8bRKRTbS5i18l5zoAniqw9gHgR6VW-0-9c4e52e75813a8b21c5de57afd36fc57)
图1-5-26 肾窝放置引流管
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-27_6700.jpg?sign=1739592144-ID3V27sFVyPd4s2WLRBm39Z7cCzGCHYL-0-af1622fef314df478818c004c23b58d1)
图1-5-27 取出标本
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-28_6702.jpg?sign=1739592144-dyeHEvBbZFmZDVM0FZA1WZacOIFmiowg-0-30012ba8a6cc17de9cab5e9b5d27b329)
图1-5-28 标本