后腹腔镜下重复肾病肾和输尿管切除术的策略

Strategy of retroperitoneoscopic heminephroureterectomy for duplex kidney and ureter anomalies

目的：探讨腹腔镜下重复肾病肾切除术的手术技巧及其疗效。方法：对19例重复肾患者进行了后腹腔镜下重复肾病肾和输尿管切除术。19例均为上位重复肾伴完全型重复输尿管畸形,其中左侧8例,右侧11例。结果：19例患者手术均顺利在后腹腔镜下完成,术中、术后均未出现明显并发症。手术时间平均110（80~180）min,出血量平均80（50~200）ml,术后住院时间平均6.6（5~9）d。术后随访3~48个月,下位健肾功能良好。结论：后腹腔镜下重复肾病肾和输尿管切除术具有创伤小、术后恢复快等优点,可作为治疗重复肾、输尿管畸形的可靠方法之一。但操作难度较大,对于初学者来说应慎重。

Objective：To investigate the techniques and clinical effectiveness of retroperitoneoscopic heminephroureterectomy for the treatment of duplex kidney and ureter anomalies.Method：Nineteen patients underwent retroperitoneoscopic heminephroureterectomy.All the duplex kidneys located on the upper pole and combined with complete ureteral duplications,with eight cases on the left side and 11 cases on the right side.Result：All retroperitoneoscopic operations were performed successfully without conversion to open surgery.No severe complications occurred during the intraoperative and postoperative period.The mean operation time was 110（range,80-180）min,and the mean blood loss was 80（range,50-200）ml.Mean postoperative hospital stay was 6.6（range,5-9）d.Over 3-48 months follow-up period the function of the lower pole of all patients’ unaffected kidney was well.Conclusion：Retroperitoneoscopic heminephroureterectomy is safe and effective with the advantages of little trauma and fast recovery,and can be a faithful choice to treat the patients with duplex kidney and ureter anomalies.However,operation skills should be paid attention to for the beginners because of its difficulty.