后腹腔镜肾切除治疗结核性无功能肾临床分析

Treatment of tuberculous non-functional kidney with retroperitoneal laparoscopic nephrectomy

目的总结后腹腔镜结核性无功能肾切除的技术要点和方法,探讨后腹腔镜结核性无功能肾切除术的可行性。方法回顾分析2005年3月至2009年12月收治的46例结核性无功能肾患者临床资料,所有患者均经后腹腔镜行肾切除术,观察手术时间、术中出血量、手术并发症、术后患者恢复时间等指标。结果 46例手术均获得成功,无中转开放。手术时间45～240min,平均(102±36.9)min;出血量10～300 mL,平均(59.8±49.6)mL,术后1～3 d肠道功能恢复,术后住院时间5～9 d,平均6.5 d。术后所有患者未出现切口感染及切口不愈合。术后随访6个月至5年,无结核复发。结论后腹腔镜结核肾切除术创伤小、出血少、恢复快,但由于粘连较重,分离较为困难,因此,对有较好腹腔镜操作经验的医生而言,是一种安全、可靠的手术方法。

Objective To summarize major skills in treating tuberculous non-functional kidney with retroperitoneal laparoscopic nephrectomy and to explore its feasibility.Methods The clinical data of 46 patients with tuberculous non-functional kidney who received retroperitoneal laparoscopic nephrectomy in our institute from March 2005 to December 2009 were retrospectively analyzed.The operation time,intra-operation bleeding volume,complications and postoperative recovery time were observed.Results Operations were succeeded in all 46 patients with no conversion.The operation time was 45～240 minutes,（102±36.9）minutes in average;blood loss was 10～300 mL,（59.8±49.6）mL in average;recovery time of gastrointestinal function was 1~3 days;postoperative hospitalization duration was 5～9 days,6.5 days in average.No wound infection and disunion was found postoperatively.The follow up lasted for 0.5~5 years without relapse.ConclusionRetroperitoneal laparoscopic nephrectomy is characterized by minimally invasive,less blood loss,fewer complications,shorter hospital duration and rapid recovery of gastrointestinal function,however,it is comparatively safe and reliable for experienced doctor to do the operation because of the adhesiveness of tubercles and difficulty of the dissection.