外科肾

The surgical planes in the left colectomy are between the colorectal mesenteries and the continuous prerenal fascia.

左半结肠切除术的外科平面统一于结直肠系膜与连续的肾前筋膜之间。

Methods Three hundred and fifty patients for laparoscopic surgery were admitted to our department from August 2001 to February 2002. They included 45 cases of adrenal glands surgery, 55 simple nephrectomy, 25 radical nephrectomy, 11 nephroureterectomy, 3 partial nephrectomy, 110 renal cyst decortication, 4 polycystic kidney decortication, 12 ureterolithotomy, 16 pyeloplasty, 3 retrocaval ureteroplasty, 58 varicocele-varix ligation and 8 pelvic lymph node dissection.

从2001年8月～2004年2月，350例患者施行了腹腔镜下泌尿外科手术，其中肾上腺手术45例，单纯肾切除55例，根治性肾切除25例，肾输尿管全切11例，肾部分切除3例，肾囊肿去顶术110例，多囊肾去顶减压术4例，输尿管切开取石术12例，UPJ成型术16例，腔静脉后输尿管成型术3例，精索静脉高位结扎术58例，盆腔淋巴结切除术8例。

It is necessary to block renal circulation temporarily in some complicated renal operations such as nephropyelolithotomy and nephron sparing nephrectomy of renal tumors.

在泌尿外科领域一些复杂的，肾脏手术，如肾实质切开取石术，肾肿瘤的肾部分切除术，暂时阻断血流是必要的。

And There was no serious complication;②In the course ofinterventional therapy, Direct portal vein angiography demonstrated vena coronaria ventriculi(100%)andgastricveins(65.26%)andvenagastricaposterior38.43%, Angiography demonstrated venacoronariaventriculi communicate esophagus varicose veins, gastric veins and vena gastrica posterior communicategastric varicose veins. vena coronaria ventriculi had only a small percentage of double vein, about30.57%. The sites of vena coronaria ventriculi arising from the portal vein, splenic vein, portosplenic junction, were found in 52.06%、27.39%、20.55% respectively.③12 extrahepaticprotosystemic shunts were found in these patients. Include gastro-nephrosshuntof 3 cases, 7 caseswere splenetic- nephros shunt and 2 cases shown recanalization of umbilical vein .④The averageportal pressure before and after the procedure were 3.87±1.82kPa and 3.64±1.14kPa in 73patients, but to the time of rebleeding, it was 3.96±0.23kPa in the 11 cases.⑤There werethree kinds of variceal outcome: disappearance (54,low degree (19).⑥Spearman logisticanalyse and ANOVAtest shown liver function class, variceal degree of the splenic necrosis area,the blood direction in portal vein before operation and remain small collateral routes were thesignificant factors concerning outcome of varices.⑦The bleeding volume and portalhypertensive gastropathy are main risk factors of rebleeding.⑧The course of livercirrhosis is the risk factor of survival and extrahepatic portosystemic shunt , fine varices are thebeneficial factors to survival.⑨During all cases'followed-up data, the 1, 2, 3, 4, 5 yearcumulative survival rates and rebleeding rates were 17.81%, 28.77%, 38.36%, 43.84%, 47.95%and93.15%,91.78%,86.30%,83.56%,80.82%respectively. Conclusion The interventional disconnection treatment for liver cirrhosis and portalhypertension was designed suitability. It rapidlycontrol bleeding,butpressure of portal vein was notobvious high, perfusion was not low .it was compared with surgery therapeutic that interventionaldisconnection treatment was safe and had a significant clinical effect to hemorrhage and preventfrom rebleeding.

结果：①术后一过性发热62例(84.9%)，腹痛腹胀48例(65.8%)是介入断流术常见的并发症，未发生严重并发症；②门静脉造影显示胃冠状静脉、胃短静脉和胃后静脉的曲张分流的出现率是100%、65.26%和38.34%；显示食管静脉曲张主要由胃冠状静脉供血，胃静脉曲张主要由胃短静脉和胃后静脉供血；胃冠状静脉大多数为单支，少数为双支，其双支的出现率分别为30.57%；胃冠状静脉开口于门静脉主干的为52.06%，开口于脾静脉主干的为27.39%和开口于门脾静脉交汇处的为20.55%；③发现胃肾分流3例，脾肾分流7例、腹膜后门腔静脉分流2例，以及CTA检查发现脐静脉开放者2例；④73例患者介入断流术前和术后平均自由门静脉压力分别为3.87±1.82kpa和3.64±1.14kpa，前后比较存在显著性差异；11例再次介入手术患者的术前、术后和复发后的自由门静脉压力分别为4.02±0.24kpa、3.82±0.25kpa和3.93±0.23kpa ，前后比较发现首次术前与术后存在显著性差异，首次术前和复发出血术前门静脉压力比较无显著性差异；⑤介入术后复查曲张静脉转归基本消失54例，轻度19例；⑥Spearman相关分析和Logistic多因素回归分析，肝功能分级、静脉曲张程度、门脉血流方向和残存小侧支四个因素对曲张静脉转归有影响；Spearman相关分析和Logistic多因素回归分析门脉高压性胃病和出血量等因素对复发出血时间有影响；⑦COX回归分析，门体分流和曲张静脉转归两个因素对术后生存有影响；⑧术后随访6-70月，1、2、3、4、5年的累计复发出血率和累计生存率分别为17.81%、28.77%、38.36%、43.84%、47.95%和93.15%、91.78%、86.30%、83.56%、80.82%；结论：介入断流术治疗门脉高压食管胃底静脉曲张有独特的优点，可以快速直接控制曲张静脉出血而门静脉压力无显著增高，保证了肝脏灌注；与外科分流术相比适应证广、损伤轻、术后恢复快，不易遗漏曲张静脉；肝功能分级、曲张静脉程度、门脉血流方向和残存侧支血管对食管胃曲张静脉转归有影响；门脉高压性胃病对复发出血时间有影响；门体分流和曲张静脉转归对生存时间有影响。

Objective To evaluate DSA and percutaneous transluminal renal arterioplasty for the treatment of renovascular hypertension.

目的 评价经皮腔内肾动脉成形术治疗肾血管性高血压的价值方法 82例全部行DSA检查，肾血管狭窄者行PTRA术或外科手术，观察其治疗效果。

objective to evaluate dsa and percutaneous transluminal renal arterioplasty for the treatment of renovascular hypertension.methods 82 suspected patients with renovascular hypertension were given dsa examination.28 patients were treated by means of ptra while another 5 cases with unilateral kidney atrophy treated surgically.results 49 patients were normal,33 patients were abnormal,28 patients were treated by means of ptra.blood pressure had got to normal in 10 patients while in 13 patients bp dropped noticeably after ptra.the overall benefit rate was 82.1%.conclusion dsa and ptra are clinically effective for the treatment of renovascular hypertension.ptra is technically successful.

目的 评价经皮腔内肾动脉成形术治疗肾血管性高血压的价值。方法 82例全部行dsa检查，肾血管狭窄者行ptra术或外科手术，观察其治疗效果。结果 82例患者行肾动脉造影后血管正常者49例，异常者33例，其中单侧肾萎缩5例行外科手术（肾动脉搭桥1例），肾动脉狭窄28例行经皮腔内肾动脉成形术（血管内支架5例），术后10例血压降至正常或基本正常，13例血压得到改善，5例无效，总有效率达82.1%。结论 dsa检查和ptra术在诊断和治疗肾血管性高血压方面有明显的临床价值。高血压，肾血管性；数字减影血管造影术；经皮腔内肾动脉成形术

Since Clayman successfully performed laparoscopic nephrectomy for an oncocytoma patient in June 1990, the laparoscopic technique in urology has been developed dramatically.

自从Clayman于1990年6月成功地为一位肾脏嗜酸细胞瘤患者施行腹腔镜肾切除术以来，腹腔镜技术在泌尿外科领域得到了较快的发展，尤其是随后5年，在肾、肾上腺、前列腺癌及输尿管结石的外科治疗方面，越来越多的泌尿外科医生开始采用这一技术，并且泌尿外科腹腔镜水平的高低成为衡量医院综合竞争力的重要标准之一。

Gutt GN%Kim Z%Krahenbtlhl L Training for advanced laparoseopic surgery European Journal of Surgery , 2002,null

张旭%李宏召腹腔镜下保留肾单位手术治疗肾肿瘤现状中华泌尿外科杂志， 2007，7

From May 1992 to Nov.1996,141 patients (110 males and 31 females) were subjected to laparoscopy in the treatment of urological diseases. The age of the patients ranged from 9 to 76 years (mean 39 years). Five patients had nephrectomy, 12 adrenalectomy,48 renal cyst resection,61 high ligation of internal spermatic vein,5 pelvic staging lymphadenectomy,9 orchiectomy, and 1 removal of bladder diverticulum.

1992年3月～1996年11月应用腹腔镜技术治疗泌尿外科疾病141例(男110例，女31例，年龄9～76岁)，其中肾切除术5例，肾上腺肿瘤切除术12例，肾囊肿去顶术48例，盆腔淋巴结切除术5例，精索内静脉高位结扎术61例，以及隐睾探查或切除9例，膀胱憩室切除1例。

Two 10 mm trocars and one 5 mm trocar were placed in the lumber part. The renal artery and vein were exposed and dissected. Both renal arteries and veins were secured by placing 2 clips (13 mm Hem-n-luck) on the patient side and 1 clip (13 mm Hem-o-lock) distally on specimen side.

根据肾动脉搏动找到并分离出肾动脉，游离肾动脉至适当长度，用13 mm威克外科结扎锁(Hem-o-lok， Weck Closure Systems)处理肾动脉，肾动脉近心端以2枚夹闭，远心端以1枚夹闭，切断肾动脉，同法处理肾静脉。

As she looked at Warrington's manly face, and dark, melancholy eyes, she had settled in her mind that he must have been the victim of an unhappy attachment.

每逢看到沃林顿那刚毅的脸，那乌黑、忧郁的眼睛，她便会相信，他一定作过不幸的爱情的受害者。

Maybe they'll disappear into a pothole.

也许他们将在壶穴里消失