后腹腔镜下肾实质切开取石术的临床应用(附6例报告)

Clinical application of retroperitoneal laparoscopic nephrolithotomy:with a report of 6 cases

目的：总结后腹腔镜肾实质切开取石术的临床应用价值及手术经验。方法：回顾分析6例后腹腔镜肾实质切开取石患者的I临床资料，其中男4例，女2例，平均（56．6±13．9）岁，采用全麻，取健侧卧位经腹膜后入路行腹腔镜手术。术中切开Gerota筋膜，游离肾脏，切开靠近结石处的肾实质取石，冲洗管置入肾脏内冲洗，肾孟内留置双J管，间断缝合肾实质，留置肾周引流管后结束手术。结果：6例手术均顺利完成，无一例中转开放手术。手术时间130～280min；平均（171．6±56．4）min；术中出血量30～200ml，平均（93．3±62．5）ml；术后平均（3．3±0．5）d拔除肾周引流管，平均（5．5±2．4）d拔除尿管，平均住院（22．0±6．1）d。术后随访6个月，无结石残留及并发症发生。结论：后腹腔镜肾实质切开取石术具有暴露好、并发症少、手术时间短、康复快等优势，为微创取石提供了新途径，是治疗肾结石的有效方法之一。

Objective：To summarize the clinical application value and operative experience of retroperitoneal laparoscopic nephrolithotomy. Methods：The clinical data of 6 patients who underwent retroperitoneal laparoscopic nephrolithotomy were retrospec- tively analyzed. The patients included 2 females and 4 males, with the average age of （56.6 ±13.9） years. In the operation, general an- esthesia, contralateral decubitus and retroperitoneal approach were applied. Gerota fascia was opened, kidney was separated, and renal parenchyma near the calculus was incised to remove the kidney calculi. Kidney was douched after irrigating tube was placed, double-J tube was indwelled in renal pelvis, and the renal parenchyma was interruptedly sutured. Drainage tube was placed around the kidney. Results：Six operations were successfully completed without conversion to open surgery. The operation time ranged from 130 to 280 rain with the average of （ 171.6 ± 56.4） min. The blood loss was 30-200 ml with the average of （93.3 ± 62.5） ml. The drainage tube was removed （3.3 ± 0.5） d after the operation, and urinary catheter was removed in postoperative （5.5 ± 2.4） d. The average of hospital stay was （22.0 ± 6.1 ） d. No residual calculi or complications were found in the following six months. Conclusions： The retroperitoneal laparoscopic nephrolithotomy has advantages of easier exposure, fewer comphcations, shorter operation time as well as quicker recovery. It offers a new method of mini-invasive stone extraction technique and is one of the effective options of the treatment for renal calculus.