后腹腔镜半肾输尿管切除术治疗成人重复肾24例报告

Retroperitoneoscopic heminephroureterectomy for the treatment of duplex kidney in adults （report of 24 cases）

目的探讨后腹腔镜半肾输尿管切除术治疗成人重复肾的手术方法和临床效果,并介绍一种防止术后尿性囊肿的方法。方法采用后腹腔镜半肾输尿管切除术治疗成人上半重复肾患者24例。男9例,女15例。平均年龄21岁。左侧11例,右侧13例。术中同时实施肾盂黏膜剥离术。观察手术时间、术中出血量和术中术后并发症及手术效果。结果24例手术均成功。手术时间55～108 min,平均78 min。术中出血量10～35 ml,平均22 ml。术后住院时间5～7 d,平均6．2 d。术中和术后未出现明显并发症。随访3～45个月,平均29个月,下半肾功能良好。结论后腹腔镜半肾输尿管切除术治疗成人重复肾具有创伤小、出血少、恢复快等特点。剥离肾盂黏膜是一种有效预防术后尿性囊肿发生的方法。

Objective To evaluate the technical feasibility and clinical efficacy of retroperitoneoscopic heminephroureterectomy for the treatment of adults with duplex kidney. Methods Retrope- ritoneoscopic heminephroureterectomy was performed on 24 patients （9 males and 14 females）. Of the procedures,13 cases were on the right side and 11 on the left. Mean age at surgery was 21 years （range, 16 to 35）. The stripping off the mucous membrane of the remnant collecting system was made simultaneously. The operating time, blood loss, intraoperative and postoperative complications and the operative efficacy were observed Results All retroperitoneoscopic operations were performed successfully without conversion to open surgery. Mean operative time was 78 min （range, 55 to 108）. The mean blood loss was 22 ml （range, 10 to 35）. Mean postoperative hospital stay was 6.2 days （range, 5 to 7）. No intraoperative and postoperative complications occurred. The function of the lower pole was well in all patients at a mean follow-up of 29 months. Conclusions Retroperitoneoscopic heminephroureterectomy has the benefits of mini-invasion, less blood loss, quicker recovery for adults with duplex kidney. Stripping off the mucous membrane of the remnant collecting system could be an efficient technique to prevent urinoma.