肾切除术

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。

However, adjunctive nephrectomy is only recommended for patients with good performance status.

然而，这额外的肾切除术只建议用在状况良好的病患上。

Result:Among total of 80 cases with non-visualized kidney in IVP,renal parenchyma of 37 cases were non-visualized under ~(99m)Tc-DTPA renography,GFR was 0 ml/min,32 cases carried out nephrectomy;Renal parenchyma of the rest 43 cases were visualized under ~(99m)Tc-DTPA renography,GFR were(20.03±9.64) ml/L,among them 9 cases were carried out nephrectomy, 34 cases received kidney-sparing operation;The 34 cases(divided into 4 groups according to range of GFR) recheck ~(99m)Tc-DTPA renography 2 months later after the operation,Preoperative GFR within(1～10) ml/min,GFR were(4.25±2.99) ml/min,postoperative GFR were(4.00±2.94) ml/min,t=0.522,P＞0.05,indicated no significant change of GFR after the operation; Preoperative GFR within(11～20) ml/min、(21～30) ml/min、(31～40) ml/min groups, preoperative GFR were(15.38±2.63) ml/min、(24.83±2.92) ml/min、(34.25±2.75) ml/min, postoperative GFR were(17.77±3.79) ml/min、(29.42±3.90) ml/min、(40.25±3.50) ml/min respectively,paired t-test,P＜0.05,indicated that 2 months\' postoperative GFR increased significantly,the function of kidneys recovered in some degree.

结果：在80例IVP不显影患肾中，37例患肾在~(99m)Tc-DTPAI肾动态显像上肾实质不显影，GFR为0 ml/min，其中32例行患肾切除；43例患肾在~(99m)Tc-DTPA肾动态显像上肾实质显影，GFR为(20.03±9.64)ml/L，其中9例行患肾切除，34例行保留肾手术；34例保留患肾手术者(根据术前GFR在不同值范围分为4组)在术后2个月返院复查~(9m)Tc-DTPA肾动态显像，GFR值在(1～10)ml/min组(5例)，术前GFR为(4.25±2.99)ml/min，术后2月GFR为(4.00±2.94)ml/min，t=0.522，P＞0.05，表明术后GFR无明显变化；术前GFR在(11～20)ml/min(13例)、(21～30)ml/min(12例)、(31～40)ml/min组(4例)，术前GFR分别为(15.38±2.63)ml/min、(24.83±2.92)ml/min、(34.25±2.75)ml/min，术后2月复查GFR分别为(17.77±3.79)ml/min、(29.42±3.90)ml/min、(40.25±3.50)ml/min，经配对t检验，P＜0.05，有统计学意义，术后2月GFR较术前增高，肾功能有不同程度的恢复。

The positive rates of retrograde ureteropyelography,CT scanning,IVP,ultrasonography were86.7%、50%、12.5%、12.5%respectively.31of40cases were treated by total nephroureterectomy with segmental cystectomy,3cases by segˉmental ureterocystectomy with ureteroneocystostomy,2cases by segmental ureterectomy with end-to-end anastomoˉsis,2cases by single resection of tumor,2cases by resection of residual ureter with segmental cystectomy.

逆行输尿管插管造影、CT、IVP、B超检查的阳性率分别是86.7%、50%、12.5%、12.5%。40例患者中行患肾+全段输尿管+膀胱部分切除术31例，输尿管下段切除术+膀胱吻合术3例，输尿管肿瘤切除+输尿管端端吻合术2例，单纯输尿管肿瘤切除术2例。

Methods: Between November 2003 and December 2005, 67 patients with renal cell carcinoma underwent retroperitoneal laparoscopic radical nephrectomy (34 patients, group A) and open radical nephrectomy (33 patients, group B). Operating time, blond loss, amount of postoperative drainage, time to ambulation, recovery of intestinal function after operation, the postoperative hospital stay, use of antalgesic and transfusion blood and plasma were compared between group A and group B, retrospectively. Results: In group A, the operations of 31 patients were successful and 3 cases failed, then conversed to open surgery. Firstly, one case were not decented the prerenal fascia and the other two cases occurred complications, one case was due to injurying genital gland vein, with blood loss of 500m1, another fatty renal capsula was too thick to explose the renal pedicle. The operations of group B were all successful, only one case was died of intracerebral hemorrhage after two monthes.

回顾性分析和比较后腹腔镜肾癌根治性切除术(Retroperitoneal laparoscopic radical nephrectomy， RLRN)34例与开放性肾癌根治性切除术(Open radical nephrectomy， ORN)33例，比较两种方法的手术时间、术中出血、术后引流、术后最早下床活动时间、肠功能恢复情况、术后住院时间、术后镇痛剂使用量、术中术后输血、血浆量、术后随访时间及手术效果结果：A组中1例因最初对解剖结构难于辨认，无法分离肾前筋膜至肾门而改行开放手术，1例因损伤精索静脉出血难以控制而改行开放手术，1例因肾周脂肪过多，无法将肾脏掀起显露肾蒂而行开放手术，31例手术成功。B组手术均获成功，1例术后2个月因大面积脑出血死亡，余均无瘤生存。

Surgical strategies included: 23 cases with meso-caval shunt, 8 cases with splenectomy and spleno-renal vein shunt, 1 case with porta-caval shunt, 2 cases with paraumbilical vein-jugular vein shunt, 3 cases with portal azygous disconnection, 1 cases with splenectomy and portal azygous disconnection, 1 case with sigmoidostomy and closed the fistula of sigmoid six months later, 1 case with resection of part of small intestine due to acute extensive thrombosis of portal vein system, 4 cases with selective superior mesenteric artery and splenic artery thrombolytic infusion therapy, 2 cases remained no-surgical option and underwent conservative treatment.

行肠系膜上静脉-下腔静脉分流术23例；脾切除、脾静脉-肾静脉分流术8例；门静脉-下腔静脉分流术1例；附脐静脉-颈内静脉分流术2例；门奇静脉断流术3例；脾切除、门奇静脉断流术1例；乙状结肠暂时性造瘘，6个月后闭瘘1例；大部分小肠切除术1例；经股动脉插管溶栓4例；未行手术2例，仅给予护肝及对症治疗。

The conalescence results and oncologic outcomes were analyzed and compared with the corresponding data from 41 contemporary conentional open nephroureterectomy procedures.

分析患者恢复情况以及肿瘤细胞学结果并与41例同时行传统开放性输尿管肾切除术者的相应资料进行比较。

In the 6 years since the publication of the first volume of Recent Advances in Endourology by the Japanese Society of Endourology and ESWL, data on long-term oncological or functional outcomes have been collected in several related fields, and advances in surgical techniques and improved instrumentation have led to further development of such complex surgery as laparoscopic partial nephrectomy and radical prostatectomy.

泌尿生殖的癌(在Endourology方面的新近的发展)的Endourological 管理从Endourology 和ESWL的日本社会的在Endourology方面的新近的发展的第一个量的出版起在6 年，在长期的oncological或者功能的结果上的数据已经被在几个有关的领域收集，在外科技术内前进并且改进器械操作导致象腹腔镜检查部分的肾切除术和基本的prostatectomy这样的复杂手术的更进一步发展。

Objective To study the treatment and diagnosis of postcaval ureter.Methods Among8cases with postcaval ureter,6cases underwent ureteroureterostomy before vena cava,1case ureteroureterostomy after cutting inferior vena cava,1case right nephrectomy.

目的 探讨腔静脉后输尿管的临床诊断与治疗方法对8例腔静脉后输尿管中6例行腔静脉端端吻合，1例切断下腔静脉再吻合，1例行右肾切除术。

Methods Among8cases with postcaval ureter,6cases underwent ureteroureterostomy before vena cava,1case ureteroureterostomy after cutting inferior vena cava,1case right nephrectomy.

对8例腔静脉后输尿管中6例行腔静脉前端端吻合，1例切断下腔静脉再吻合，1例行右肾切除术。

However, as the name（read－only memory）implies, CD disks cannot be written onorchanged in any way.

然而，正如其名字所指出的那样，CD盘不能写，也不能用任何方式改变其内容。

Galvanizes steel pallet is mainly export which suits standard packing of European Union, the North America. galvanizes steel pallet is suitable to heavy rack. Pallet surface can design plate type, corrugated and the gap form, satisfies the different requirements.

镀锌钢托盘多用于出口，替代木托盘，免薰蒸，符合欧盟、北美各国对出口货物包装材料的法令要求；喷涂钢托盘适用于重载上货架之用，托盘表面根据需要制作成平板状、波纹状及间隔形式，满足不同的使用要求。