后腹腔镜下脂肪囊内结核肾切除术

Retroperitoneoscopic nephrectomy inside the fatty renal capsule for tuberculous nonfunctioning kidneys

摘要：目的探讨后腹腔镜下脂肪囊内切除结核肾的手术方法、疗效及临床应用价值。方法行后腹腔镜下脂肪囊内结核肾切除术10例。病变位于左侧7例，右侧3-g4。临床表现主要有反复发热、膀胱刺激征、腰痛、痛性或无痛性肉眼血尿及脓尿。术前经尿AFB及尿Tb—pcR及尿结核杆菌培养、泌尿系彩超、Ivu、CT和ECT等检查诊断为单侧重度受损或无功能肾结核，对侧肾功能正常或代偿良好。其中合并肾萎缩2例、肾结石2例、附睾结核1例、膀胱挛缩1例以及合并肾上腺肿瘤1例。术前常规服用三联抗结核药2周-2个月后行后腹腔镜下结核肾切除术。结果除2例因肾动静脉周围粘连严重而中转开放手术外，8例均成功完成手术。手术时间80一150min，平均117min；出血量10～180mL，平均62．5mL，术中及术后均未输血；术后住院4～8d。平均5．5d。术后病理诊断为结核肾10例，其中合并输尿管结核4例。术后继续抗结核治疗满6个月。10例患者术后随访6～12个月均治愈，预后良好。结论掌握正确的分离平面，可靠处理肾蒂及血管是后腹腔镜下结核肾切除术的关键，肾脂肪囊内游离结核肾具有出血少、创伤小以及恢复快等优点。

[Objective] To investigate the operative methods, effects, and clinical value of retroperitoneo- scopic nephrectomy inside the fatty renal capsule for tuberculous nonfunctioning kidneys. [Methods] Retroperitoneescopic nephrectomy was performed on 10 cases, 7 of whom had the lesion on the left kidney and 3 on the right. Clinical presentations appeared with repeated fever, irritative symptoms, lumbago, painful or painless hematuria and pyuria. It is suggested that one kidney was nonfunctional or tuberculous kidney severely damaged while the other side is in normal function or compensated well, Diagnose them with urinal AFB, tuberculosis PCR, Urine mycobacterium tuberculosis culture, urinary color ultrasound, IVU, CT, ECT etc. before operations. 8 cases were diagnosed as tuberculous nonfunctioning kidneys and 2 were nonfunctional nephrarctias. Among these cases, 2 were combined with renal calculi, one was tuberculosis of epididymis, and another was contracture of bladder and the last one was adrenal tumor. Retroperitoneoscopic nephrectomy was practiced after 2 weeks to 2 months therapy of triple anti-tuberculosis medicine. [Results] All operations were performed successfully except 2 cases were taken to open operations for serious renal arteriovenous adhesion around. The operation time was 80~150 min （mean 117 min）; the blood loss volume was 10-180 mL （mean 62.5 mL） and stay in hospital after operation about 4-8 days （average 5.5 days）. Postoperative patho- logic diagnosis showed 7 cases were nephrotuberculosis and 3 cases were chronic pyelonephritis. Keep anti-tu- berculosis therapy for 6 months after operations. 10 patients showed satisfactory effects in the following 6-12 months. [ Conclusion] It is the vital key to achieve the range and plane of dissecting and dispose of the re- nal pedicle safely for retroperitoneoscopic nephrectomy for tuberculous nonfunctioning kidneys. Separating renal tuberculosis inside the fatty renal capsule has advantages of minimal invasion, less blood loss and quicker re- covery.