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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)。
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图1-5-4 打开侧腹膜
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图1-5-5 推开十二指肠
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图1-5-6 打开下腔静脉鞘
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图1-5-7 游离肾门动静脉
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图1-5-8 夹闭动静脉
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图1-5-9 离断动静脉
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图1-5-10 游离肾脏上极
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图1-5-11 游离肾脏下极
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图1-5-12 游离输尿管中上段
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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)。
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图1-5-14 下腹部加一操作孔
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图1-5-15 游离回盲部及部分升结肠
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图1-5-16 暴露下段输尿管及髂血管
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图1-5-17 右侧髂内血管
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图1-5-18 沿着髂内血管游离
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图1-5-19 完全暴露髂内血管
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图1-5-20 移植肾动脉与髂内血管吻合处
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图1-5-21 输尿管肿瘤处
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图1-5-22 沿着输尿管向下游离
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图1-5-23 游离输尿管壁段
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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)。
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图1-5-25 盆腔放置引流管
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图1-5-26 肾窝放置引流管
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图1-5-27 取出标本
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图1-5-28 标本