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1、腹腔镜肾切除术中并发症的腔镜处理-腔镜热潮中的思考,Introduction,微创始终是医生与患者追求的方向腹腔镜肾癌根治术已成为大多数 肾癌的标准治疗术式。,Introduction,微 创,A surgical career is interspersed with incredible highs and incredible lows.The exhilaration one feels when a procedure goes well can be followed the next day by a devastating complication.,Kevin R.Lough
2、lin,危 创,不恰当的治疗方式+不规范的操作,2775 Laparoscopies(22.1%),1993-2005,并发症的分类,Text in here,Text in here,侧卧位抬高腰桥，长时间过伸位可造成腰部肌肉或坐骨神经牵拉损伤。上肢长时间过伸位可造成尺神经损伤。,Positioning Complications,General Complications,气腹针或Trocar穿刺损伤、与气腹有关的皮下气肿、气体栓塞、高碳酸血症以及切口疝等。,Pedicle orientation during LRN,Right,Left,腹膜损伤,不影响操作可不处理钛夹或Hemolok
3、处理,连续或8字缝合打结前使肺膨胀,膈肌损伤,静脉壁小孔的处理,Errors in dissection小破损暂不处理,肾静脉被剪断的处理,Vascular Injuries：1.6-4.7%Cut only what you see！,下腔静脉的损伤,CompressionSupplementary PortSuturing(8-10cm),动脉损伤,冷静会带来智慧！,脾脏损伤,Elective conversion is”a sign of wisdom”,The most delicate point is the timing of when a conversion is required!,预防手术并发症的 Key Point,C-Concept 理念A-Anatomy 解剖S-Skills 技能E-Emergency 急智,A,S,E,C,Take Home Message,一台完美的手术，技巧只占25%，其75%是决策。决策是在正确的诊断基础上，正确地选择手术的适应证，对术式和范围的合理设计，对可能出现并发症的防范和对策。“The good surgeon believes what he sees;the bad one sees what he believes.”,“精致手术”,Delicate Surgery,谢谢！,
