![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=1739001635-8slzoTnZgdaTrobImYyvxXHOK0dvc1xt-0-2459395c0446f1a7be15c735d1cbe384)
图1-5-4 打开侧腹膜
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-5_6667.jpg?sign=1739001635-h9fpR9C7mn9V6sexKuOr01RugTdn5Qeu-0-622e00a5eb90e0143ca2766e4a325c28)
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=1739001635-xXVca3BuTYvrAAT9FiNH3Ja5capA6cGk-0-5a2089672fbc553d50ac355971b458e1)
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=1739001635-liVx2Bqh3AjxYols6KPZWeIxPMNVDaIX-0-b10f75f12f79f4b0822a4d2deafd01bb)
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=1739001635-5TOUgfytJwqRyzWdfpVFSo2lSiJTPeYL-0-d5a26539b9386255e590f8a5222b9f1b)
图1-5-8 夹闭动静脉
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-9_6673.jpg?sign=1739001635-bHcpDawraDDzNMDX2a8NYNvyx0WKihze-0-b652c5bf21a1610c8938b50a13de7015)
图1-5-9 离断动静脉
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-10_6675.jpg?sign=1739001635-lQqRoRhu7eK2AVSiFsYumiE2Pw1runma-0-0942b99438569124fa2935f02074849f)
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=1739001635-TLqQlufYZXwRp8RJMy31GfJgbjZLM4dV-0-0ab66d9fe671f906174d2bd554b9be09)
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=1739001635-oHXUuSzLRRHhioyV2hWOHZ6IbKYOLKFq-0-c949e2067b08b206cfc1f8e2d03d6eb3)
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=1739001635-PV9Pxxeg5c8MY4GY6Y0ldjrlQJfSn3iZ-0-2dfb18bbec05dc567a7207db1e839f8b)
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=1739001635-BHu3JAJhGPnnf0LLb2ZtC5QZSVnMUcxR-0-a23a6f146f174664a3d91b609c6c55b4)
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=1739001635-398vmcbbYZmjfacl8M2TbFCABaKVsikk-0-dc9b702ed1a53f9e4805ef1ad807dd73)
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=1739001635-ETe1BOgQbnMFtjK51o7URuVHIA8IQaCl-0-b927dc82fb28be32c683cb04ddc2b339)
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=1739001635-8U4sHFxVrgF3uq3WiO6MwrfAqJNQYjYn-0-fdbd36c3d5f5c070bbcabf0ea1480a76)
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=1739001635-f7qnHNGuq7R43DOp0BCGYL3LYKX9jIZ0-0-c4aacbf5d20408916b31c1307bf16676)
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=1739001635-xx6n2eIwCri9y0QGNtYaGCKkm6OtN9vX-0-598dda89472205c5097f043d131eaecc)
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=1739001635-S7XM6L2DAMDBpOT5brXOAy0ETtcKs56n-0-3c9da7e45f315eb5c1c696ee2c21e997)
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=1739001635-OJT9aYfkovpdIpbxEvloNfb5MsPiXHkN-0-327375b4bed592061d006c5e93b8f4df)
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=1739001635-zrjPiztRG7vkpAK0plRBT4PXsH8ha7tY-0-adab8d116a7cc689ee3e6cbbf20bd59b)
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=1739001635-qmYpI3je4GrwP6hF5vvhcgtMFJFs6sBM-0-3ac16cd8c32d5e45a72f586ffa4a3c1b)
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=1739001635-x1jaluyc8L700gCkuFwd8JSif28zISC9-0-f53f61bdcad0b1e5fb8870e66ec670c9)
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=1739001635-kwgSRGKRYlX85fQEggVdYy1PN3K8XGtr-0-0f8e6adab44aa3a099f2fef86acaa1bd)
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=1739001635-xPzNhtygDgqty6PR1FiJbNUnqbzfjwMQ-0-e470443509a06b8c3db431db1aac23da)
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=1739001635-i9Wo4HzYXz65AfiCSAPjKrTcA59cBty8-0-424e4a04ebf7b6f61bd700649878ed8c)
图1-5-27 取出标本
![](https://epubservercos.yuewen.com/4644EF/18038287308103006/epubprivate/OEBPS/Images/P1-5-28_6702.jpg?sign=1739001635-cnP9hDZfQUFrnrxuniQf9v5tFxFm0xC4-0-3dab7979b5dfb0f5dc48de826cbd3f9b)
图1-5-28 标本