后腹腔镜下腔内结扎联合可吸收夹处理肾蒂行肾切除术

Combined use of endoscopic ligation with absorbable clips in handling renal pedicle during retroperitoneoscopic nephrectomy

目的探讨后腹腔镜肾切除术中腔内结扎联合可吸收夹处理肾蒂血管的临床效果。方法回顾性分析行后腹腔镜肾切除术7例,包括单纯性肾切除4例,根治性肾切除1例,肾输尿管全切除2例,术中用腔内结扎联合可吸收夹处理肾蒂血管。结果手术均获得成功,均未中转开放手术。术中处理肾蒂血管均顺利,术中、术后均未出现血管并发症。手术时间130～210 min,平均150 min;术中估计出血量20～60 mL,平均35 mL;腹膜后引流管于术后2～3 d拔除,术后住院时间5～9 d。结论后腹腔镜肾切除术中用腔内结扎联合可吸收夹处理肾蒂血管确实可靠,费用经济、术后无金属异物残留,有较好的临床应用价值,特别适用于肾蒂较短的患者及全国大多数基层医院。

[Objective] To assess the clinical effect of combined use of endoscopic ligation with absorbable clips in handling renal pedicle during retroperitoneoscopic nephrectomy. [Methods] Seven patients were retrospectively analyzed. Among them, 4 cases accepted simple nephrectomy, 1 case had radical nephrectomy and 2 cases had nephroureterectomy. Combination of endoscopic ligation with absorbable clips was used to deal with the kidney pedicle in retroperitoneoscopic nephrectomy. [Results] Retroperitoneoscopic nephrectomy was successfully performed for all 7 patients. No obvious vascular complication was observed for all the patients. The duration of operation ranged from 130 to 210 minutes （mean 150 minutes）. Intraoperative blood loss was 20 to 60 mL （mean 35 mL）. Postoperative retroperitoneal drainage tube was removed on day 2 or day 3 after operation. Postoperative hospital stay was 5-9 days. [Conclusions] Combination of endoscopic ligation with absorbable clips is a reliable method in handling the renal pedicle during retroperitoneoscopic nephrectomy. It is especially suitable for the cases of short renal pedicle and for grass-roots hospitals.