再行腹腔镜肾脏手术的可行性

Subsequent laparoscopic surgery for patients with previously undergoing ipsilateral open nephric surgery

目的：探讨既往有肾脏手术史者再行腹腔镜肾脏手术的可行性。方法：4例肾积水患者均有经腰切口肾脏手术史，其中2例经腹入路行腹腔镜肾切除，1例经腹膜后入路行腹腔镜肾切除，1例经腹膜后入路行腹腔镜肾盂成形术。结果：4例腹腔镜手术均获得成功，无术中及术后并发症发生。经腹入路手术时间平均2．5h，术中出血量约50ml，经腹膜后入路腹腔镜肾切除术手术时间3h，腹腔镜肾盂成形术手术时间4．5h，出血量80～100ml。结论：对于既往有肾脏手术史者，虽然因瘢痕粘连增加了手术难度，但随着腹腔镜手术经验的积累和手术技能的提高，再行腹腔镜肾脏手术是可行的。

Objective：To evaluate the feasibility of reoperation by laparoscopic surgery for 4 patients who have previously underwent ipsilateral open nephric surgery. Methods：4 patients with hydronephrosis who had previously undergone nephric surgery by trans-lumbar incision were performed laparoscopically, including 2 cases of transperitoneal laparoscopic nephrectomy, 1 case of retroperitoneal laparoscopic nephrectomy and 1 case of retroperitoneal laparoscopic pyeloplasty. Results： Laparoscopic surgery were successfully performed on all the 4 patients, no complication occurred. The mean operative time was average 2. 5 hours in transperitoneal approach; the mean estimated blood loss was average 50ml. The operative time in retroperitoneal laparoscopic nephrectomy and pyeloplasty was 3 hours and 4.5 hours respectively; the mean estimated blood loss was 80- 100 ml. Conclusions： Although scar and adhesion of previous operation may present more difficulties in the subsequent operation, it is feasible to perform laparoscopic surgery for rich experienced and skillful laparoscopist.