![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=1738935528-2oWpLXkAsCIpUVF1dv8RBxh8Nn0NtO7G-0-8820863a0fed4742b9f61ed84aa8876c)
图1-5-4 打开侧腹膜
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-5_6667.jpg?sign=1738935528-3HxYXqLDvGwUz9BoKMDrtGOXshXcqUsc-0-aa7bf13c9b560f59cbaa78007d08a4d3)
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=1738935528-tzlfEazb6Q64DSPxrtw4wwcg4EdJvDK5-0-a90633a3bced1057f86b3bd6669c5ad2)
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=1738935528-Ysio8E6Ryne8ZmjX1qvhxkqQk4ezsRJ0-0-5152c8d3b737571135a59197729cff80)
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=1738935528-apn0Ks9CwA3tRczLt1zZP4YZwIAgPhiW-0-9f1d1cc6fc122c162951981bc08b5024)
图1-5-8 夹闭动静脉
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-9_6673.jpg?sign=1738935528-noqKRTxozRfuoMp0YiQEgNUdd4zDjKSb-0-bdae38d9a9328bb300e93545e5915d0d)
图1-5-9 离断动静脉
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-10_6675.jpg?sign=1738935528-IePvTPXVU0ly29f8HOpJxIfYpERNey3t-0-f57bfd9e68807cbf0ba295c724bd45ac)
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=1738935528-jBLSuNh5dVXTSp6QBqe51HjUge0i9Bx5-0-7265ac5026639e7a91a1a0998359f824)
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=1738935528-FkC2bp1MbjNL1j01ALDqlKP2OonFINrz-0-27c6d613524c7cbe5a376ffe6bb50d4a)
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=1738935528-PaPuttYZ6buXL2NUnPv27KDOrRTX6cD8-0-afcd7fdadac4eccdb5f77373a3f513ab)
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=1738935528-cGKCVXDLT1jxfAi6LeU2w8HoRVZGikxW-0-d2e713dee5ae58c5fee76abb20424dff)
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=1738935528-uOZN6Ca6Xdquy7uo4AUzrmxbcIHbN6lP-0-33b9fd13b2132bd1b573966bd32e7645)
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=1738935528-nRq8hLC55B3uX34x63nS1fyK9Fqhsbkg-0-e4a5697b7d6b54b7b4d1de365f55c3e2)
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=1738935528-4asRAZ1MzQBrZHFTNyzo7NHpz9sGr7HF-0-bcdec540a680b9aac96670a51031966a)
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=1738935528-PANvWhRxuc3OWzLLi2usmJYN401TiLUR-0-318a3e34b3f98655ec31f505a656e68a)
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=1738935528-VQmpHQmq5OrdxhL6E46A1pxPf75JJSCe-0-e74d292c902bb336f0da4ac01aca1836)
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=1738935528-JQUE81JIRf73TyAwg9nFcmM3Ht6ThnZ4-0-ce51e257bc4c0ace61ee971116f4fc73)
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=1738935528-v4ba5pCm5wF5ZeViWntckT5kNl3FTsXD-0-a7e0550eb5d33969989da941937a82c6)
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=1738935528-qFYWqLRCZBxMe8h6ZRbQLqOkfWd4L5St-0-816fa5f5ddcda7c5c79d55bc4020c3f1)
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=1738935528-ULpyQ02jHZSdlmhqHjmO8eHQg5enNR8w-0-8a90ec4c4112fbcdeb1c55c28c8a86d8)
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=1738935528-ojONFFggrzCsidBJdiTVIR4QMOuqSMmv-0-9d8050f20387584e8ecda2993b048b0c)
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=1738935528-uFazwOkkQZiVpkHIxJ2MJlTgXMUxquuN-0-9f9ed8f343007ae520e0031266a311ea)
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=1738935528-UcLjErhxFSZiCwbrVIoIQ4LVV3EUL5q5-0-040679e5c6b7918a837aa2b24ea2f760)
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=1738935528-YG7lohiMJjCyZYGuzjhExj0Tf6Fl4k7n-0-b70f4f4b5ed2ff1437bf1b22f9091c48)
图1-5-27 取出标本
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-28_6702.jpg?sign=1738935528-PgbLRoyWWDsM2uDbwEOOB4hwbDV7C341-0-e400bf8f7057d4272dee8a0848722ed8)
图1-5-28 标本