后腹腔镜肾切除的临床研究

Clinical study on retroperitoneoscopic nephrectomy

目的通过与开放性肾切除比较,评估后腹腔镜肾切除的临床应用价值。方法从2003年2月至2006年10月,我科行后腹腔镜肾切除26例,其中巨大肾积水12例,肾性高血压8例(5例先天性肾发育不良、3例外伤性肾萎缩),肾盂肿瘤6例。同期开放手术36例,其中巨大肾积水22例,肾性高血压7例,肾盂肿瘤7例。记录腹腔镜组及开放组的手术时间、术中失血量、术后恢复时间、住院时间及术后应用止痛剂次数。结果腹腔镜手术组除1例因出血改为开放外,其余均顺利完成肾切除,开放手术亦均顺利完成。与开放手术相比,后腹腔镜肾切除除手术时间长外,术中出血量、术后应用止痛剂次数、术后恢复时间和住院时间均显著优于开放手术组。结论巨大肾积水致肾功丧失及肾性高血压需肾切除者应首选腹腔镜肾切除,特别是后腹腔镜手术,其可避免腹腔内并发症。对于小的肾盂肿瘤,应首先考虑腹腔镜肾切除,其可避免腰部切口,减少相应并发症。与开放手术相比,后腹腔镜肾切除具有创伤小、恢复快、出血少等优点,具有一定的临床应用价值。

Objective To evaluate the clinical safety and feasibility of retroperitoneoscopic nephrectomy. Methods From February 2003 to October 2006, retroperitoneoscopic nephrectomy was performed on 26 cases, which included 12 cases of nonfunctioning kidneys caused by hydronephrosis, 8 cases of renovascular hypertension caused by congenital renal hypoplasia and post-traumatic renal atrophy, and 6 cases of renal pelvic tumor. During the same period, open nephrectomy was performed on 36 cases, which included 22 cases of hydronephrosis, 7 cases of renovascular hypertension, and 7 cases of pelvic tumor. The operation time, intraoperative blood loss volume, postoperative usage of analgesic,and postoperative in-bed time and hospital stay, were compared between the laparoscopic and open nephrectomy groups. Results In the group of laparoscopic nephrectomy, 25 cases underwent nephrectomy and 1 case underwent intro-operative conversion to open nephrectomy because of hemorrhage of the genital vein. There was no significant difference in operation time between two groups. The amount of blood loss, postoperative usage of analgesic, in-bed time, and hospital stay revealed significant superiority of laparoscopic group to open operation group （P〈0.01）. Conclusion Laparoscopic nephrectomy may be the first choice in treatment of nonfunctioning kidney caused by hydronephrosis and renovascular hypertension, especially retroperitoneoscopic nephrectomy. Laparoscopic nephrectomy should be considered in the treatment of renal pelvic tumor. Compared with open nephrectomy, retroperitoneoscopic nephrectomy shows advantages in blood loss, operative trauma, postoperative usage of analgesic, and postoperative recoverv time and hospital stay.