【doc】腹腔镜下肾上腺肿瘤切除术

腹腔镜下肾上腺肿瘤切除术电子版2009年2月第3卷第1期CHINJENDOUROLOVELECTRONICEDITIONFEBRUARY2009VOL3NO1波能量预处理有助于减轻ESWL肾损害,但冲击波次2004,364391411数的最低阈值仍需进一步探讨GR0HO,AGAL,OVIMMITOCHON出PELILLE出血TYTRANSITIONPOREANDPOSTCONDITIONINGCARDIOVCTKES,2006,702110参考文献6DHAN,YA,STREEMTHEI“ID“MDVAFI砒一YSISOFRISKFACTORSASSOCIATEDWITHSUBCAPSULARHEMATOMAFORMATION1EVANAP,WILLISLR,MCATEERJA,ETA1KIDNEYDAMAGEANDRENALFOLLOWELECTROMAGNETICSHOCKWAVELITHOTRIPSYJUROL,2004,1715FUNCTIONALCHANGESAREMINIZEDBYWAVEFORMCONTROLTHATSUPPRESSES4951133CAVITATIONINSHOCKWAVELITHOTRIPSYJUROL,2002,1684PT115567CONNOBA,EVANAP,WILLISLR,BLOMGRENPM,LINGEMANJE,1562FINEBERGNSTHEEFFECTOFDISCHARGEVOLTAGEONRENALINJURYAND2SERELTA,OZGUNTERF,SOYUPEKSPREVENTIONOFSHOCKWAVEINIMPAIRMENTCAUSEDBYHTHOTRIPSYINTHEPIGJAMSOCNEPHROL,DUCEDRENALOXIDATIVESTRESSBYMELATONINANEXPERIMENTALSTUAY2000,112310318UROLRES,2004,32169718WILLISL,EVANAP,CONNOBA,ETA1PREVENTIONOFLITHOTRIPSYIN一3廖勇彬,梅骅,黄晓生,等人参总皂甙对高能冲击波肾细胞凋亡DUCEDRENALINJURYBYPRETREAFINGDNEYSWITHLOWENERGYSHOCK相关基因BCL2和BAX表达的影响及其临床意义中华实验外科WAVES1AMSOCNEPHROL,2006,173663673杂志,2001,183259260收稿日期200805174HOFFMANJW,GILBERTTB,P0ST0NKS,ETALMYOCARDIALREPERFUSI“本文编辑阮星星INJURYETIOLOGY,MECHANISMS,ANDTHERAPIESEXTRACORPORTECHNOL,桂西青,郭振宇,孙华宾逐步提高冲击波能量预处理对体外冲击波碎石术肾损伤的保护作用J/CD】中华腔镜泌尿外科杂志电子版,2008,316265腹腔镜下肾上腺肿瘤切除术高新手术录像腹腔镜肾上腺肿瘤切除术有4种不同的手术途径前入路经腹途径,侧入路经腹途径,侧入路经腹膜后途径和后入路经腹膜后途径临床上侧入路经腹途径和经腹膜后途径相对应用较多SUZUKI认为直径5CM的肾上腺肿瘤以及嗜铬细胞瘤等,术中需要辨认或控制肾上腺静脉者,采用经腹途径相对安全对直径5CM的肾上腺肿瘤,特别是右侧肾上腺肿瘤宜采用后腹腔途径本病例采用经腹膜后途径气管内麻醉成功后,取右侧卧位,常规消毒铺巾在左髂前上嵴上方2CM作一约15CM的横行切口,切开皮肤,筋膜,纵向钝性分开肌层,撑开腰背筋膜进入后腹腔,用手指将腹膜向前推,经切口置入自制人工气囊,注入800ML空气扩大腹膜后腔在腋中线髂嵴上2横指放一10MM曲卡,腋前线肋下置一5MILL曲卡,腋后线肋下放一10MM曲卡,腋前线髂嵴上2横指放一5MM曲卡白髂前上嵴切口置入10MM曲卡,放入腹腔镜,在腔镜监视下,找到腰大肌,向上打开GEROTA筋膜后层和肾周脂肪囊,游离左侧肾脏上极于左肾内上方见肾上腺肿瘤,实性