后腹腔镜下无功能肾切除术的临床体会

Retroperitoneal laparoscopic nephrectomy for nonfunctioning kidney

目的 探讨后腹腔镜下无功能肾切除术的临床应用价值.方法 回顾和总结54例后腹腔镜无功能肾切除术患者的临床资料.其中脓肾18例,无功能积水肾27例.所有患者施行后腹腔镜下肾切除术,结核性、感染性脓肾采用脂肪囊外切除法,无功能积水肾采用抽吸积水以增大后腹膜空间的切除方法.结果 54例均成功施行腹腔镜下切除,无一例中转开放手术,其中1例结核性脓肾因肾脏包膜撕裂致使少量干酪样脓液外溢,腹膜损伤2例,手术时间95～ 230 min,平均125min,术中出血量50 ～ 420 ml,平均84 ml.所有切口均一期愈合,术后住院时间6～11 d,平均7.5 d.随访5～ 27个月,无远期并发症.结论 后腹腔镜无功能肾切除术是一种安全、有效、可靠的微创治疗方法.

Objective To investigate the clinical application value of retroperitoneal laparoscopic nephrectomy for nonfunctioning kidney.Methods Fifty-four cases of retroperitoneal laparoscopic nephrectomy for nonfunctioning kidney were reviewed,including 9 cases with nonfunctioning tuberculosis pyonephrosis,18 cases with infection nonfunctioning pyonephrosis and 27 cases of nonfunctioning hydronephrosis.Fifty-four cases were received retroperitoneal laparoscopic nephrectomy,tuberculous and infection pyonephrosis underwent laparoscopic resection surrounding adipose capsule,nonfunctioning hydronephrosis underwent laparoscopic resection by pumping water to increase the peritoneal space.Results The operation of 54 cases were perfomed successfully.None of the patient required conversion to open surgery.During the surgery,1 case showed mild extravasation of cheese-like pus induced by laceration of the kidney capsule;2 cases had injuried on the peritoneum.The mean operation time was 125 （95-230） min,the mean blood loss was 84 （50-420） ml.All patients showed primary healing of the wound,the patients were discharged from the hospital in 6 to 11 d （mean 7.5 d）.After followed up for 5-27 months,none of them had long-term complication.Conclusions Retroperitoneal laparscopic nephrectomy for nonfunctioning kidney has advantages of minimal invasion,less blood loss and quicker recovery,so it is a fairly safe and effective procedure for nonfunctioning kidney.