后腹腔镜术切除无功能积水肾的疗效观察

Efficacy and safety of retroperitoneoscopic nephrectomy for the treatment of nonfunctioning kidney with hydronephrosis

目的：探讨后腹腔镜下切除无功能积水肾的可行性和安全性及规避手术风险的方法。方法：对62例积水无功能肾患者行后腹腔镜积水无功能肾切除术。术前常规行肾脏CT平扫及增强检奄。利用PACS系统仔细阅片，了解肾动脉分支及走向。然后建立腹膜后腔隙，参照解剖标志充分显露。肾蒂血管，用Hem-o—lok夹闭肾蒂血管后切断，分离切除患肾，留置腹膜后引流管，并统计手术时间、术中m血量和术中术后并发症，观察手术效果。结果：62例患者手术均获得成功，手术时间为50～180min，平均为130min。术中出血10～100m1．平均37ml。术中损伤腹膜3例，胸膜1例，未发现血管损伤、腹腔脏器损伤等并发症。引流管于术后2～3天拔除，术后住院5～10天，平均6．5天。结论：后腹腔镜下积水无功能肾切除术安全可行，术中通过辨认解剖标志结扎肾蒂血管和沿正确的平面游离患肾是手术成功的关键。

Objective：To explore the operation safety, efficacy and the methods of avoiding the risk of retro peritoneoscopic nephreetomy for the treatment of nonfunctioning kidney with hydronephrosis. Methods： Retroper itoneoscopie nephrectomy was performed in 62 cases with nonfunctioning kidney with hydronephrosis. All hospi talized cases were required to do the 64-Slice CT, CT imaging can reflect the renal wlscular conditions effectively in patients. During the operation,important anatomic structures such as parietal peritoneum and its reflexion, anteri- or renal fascia, lateroconal fascia, posterior renal fascia, psoas muscles, great vessels and their branches were carefully identified. Then the kidney was dissociated fully, the renal pedicle was exposed,and blocked with Hem o lok and then cut off, and the retropertoneal drainage catheter was placed. The operation time, blood loss, corn plications during and after operation and the opetative efficacy were observed. Results： 62 procedures were success fully completed,no case was converted to open surgery. The median operative time was 130 min （range 50 to 180 rain） and median estimated blood loss was 37 ml （range 10 to 100 ml）. Of all operations, peritoneum perforation occurred in 3 cases and pleura injury was observed in 1 ease. Major complication such as great vessel injury was not observed. Drainage catheter was removed 2 3 days after operation. The mean time of postoperative stay was 6. 5 days（range 5 to 10 days）. Conclusions：Retroperitoneoscopic nephrectomy for nonfunctioning kidney with hydro nephrosis was safe and feasible. Studying anatomical features of renal area and recognizing important anatomic structures will help to improve the safety of the surgery and reduce morbidities.