急性闭合性肾损伤腹腔镜肾切除术

Laparoscopic Nephrectomy Following Acute Blunt Renal Trauma

目的:探讨急性闭合性肾损伤经后腹腔途径腹腔镜肾切除术的可行性。方法:回顾性分析3例急性闭合性肾损伤经后腹腔途径腹腔镜肾切除术患者的临床资料:男2例,女1例;1例体外碎石肾损伤,2例为外伤性肾损伤。超声提示肾破裂伴肾周高回声区,考虑为血肿。CT提示肾脏破裂伴肾周血肿,血肿局限于肾周筋膜内,1例造影剂外溢。3例均行腹腔镜肾切除术,结果:3例手术均顺利完成,手术时间85 min(60～120 min),出血量180 ml(100～300 m1)。术后病理检查提示肾脏破裂。结论:在腔镜技术熟练的前提下,选择性急性闭合性肾损伤且血肿局限于肾周筋膜内患者,在伤后1周内行腹腔镜肾切除可行。

Objective：To discuss the feasibility of laparoscopic nephrectomy following acute blunt renal trauma. Methods：The data of three cases （2 men and 1 woman） of acute blunt renal trauma received laparoscopic nephrectomy were reviewed retrospectively. Three patients were referred to emergency room following traumatic re- nal trauma in 2 and ESWL in 1. Renal trauma were confirmed on computed tomography（CT）, with large retroper- itoneal hematoma. Contrast-enhanced scans demonstrated contrast extravasation in 1 patient. Results： Three patients were treated with laparoscopic ncphrectomy without conversion to open. The mean operative time was 85 min （60-- 120 rain） and average estimated blood loss was 180 ml （100 300 ml）. The pathology showed renal rupture in three cases. Conclusions： Based on skillful laparoscopic technique, laparoscopic nephrectomy following acute blunt renal trauma is feasible in carefully selected patients with hematoma contained by Gerota＇s fascia.