腹腔鏡腎切除術中并發(fā)癥的腔鏡處理

1、腹腔鏡腎切除術中并發(fā)癥的腔鏡處理 -------------腔鏡熱潮中的思考,,,Introduction,微創(chuàng)始終是醫(yī)生與患者追求的方向腹腔鏡腎癌根治術已成為大多數(shù) 腎癌的標準治療術式。,Introduction,,,,,微 創(chuàng),,A surgical career is interspersed with incredible highs and incredible lows. The exh

2、ilaration one feels when a procedure goes well can be followed the next day by a devastating complication.,Kevin R. Loughlin,危 創(chuàng),不恰當?shù)闹委煼绞?不規(guī)范的操作,,,,,2775 Laparoscopies (22.1%),1993-2005,,并發(fā)癥的分類,,,,,,,,,,,,,Text in her

3、e,Text in here,,側(cè)臥位抬高腰橋，長時間過伸位可造成腰部肌肉或坐骨神經(jīng)牽拉損傷。 上肢長時間過伸位可造成尺神經(jīng)損傷。,,,Positioning Complications,General Complications,氣腹針或Trocar穿刺損傷、與氣腹有關的皮下氣腫、氣體栓塞、高碳酸血癥以及切口疝等。,Pedicle orientation during LRN,Right,Left,腹膜損傷,不影響操作可不處理

4、鈦夾或Hemolok處理,連續(xù)或8字縫合打結(jié)前使肺膨脹,膈肌損傷,靜脈壁小孔的處理,Errors in dissection小破損暫不處理,,,腎靜脈被剪斷的處理,Vascular Injuries：1.6-4.7% Cut only what you see！,下腔靜脈的損傷,CompressionSupplementary PortSuturing (8-10cm),動脈損傷,冷靜會帶來智慧！,脾臟損傷,Electiv

5、e conversion is ” a sign of wisdom”,The most delicate point is the timing of when a conversion is required!,預防手術并發(fā)癥的 Key Point,C---Concept 理念A---Anatomy 解剖S---Skills 技能E---Emergency 急智,,,,