经皮肾镜联合后腹腔镜肾切除治疗巨大肾积水22例报告

Report of 22 Patients with Giant Hydronephrosis Treated by Percutaneous Nephroscope Set Combined Retroperitoneal Laparoscopic Nephrectomy

目的：探讨经皮肾镜联合后腹腔镜肾切除术治疗巨大肾积水无功能肾的临床意义。方法：22例患者均经CTU检查证实患肾皮质菲薄，不显影，对侧肾显影良好，ECT动态肾扫描示患肾GFR 0～3 ml/min，对侧肾GFR 55～95 ml/min，综合肾功能正常。其中CT发现输尿管中上段结石8例，14例考虑UPJ梗阻。先采用经皮肾穿刺肾镜直视下用超声探杆将肾积水吸出，以扩大后腹腔空间，再使用后腹腔镜完成肾切除。结果：22例均顺利完成手术，无中转开放手术者。平均手术时间为95 min（75～125 min），无严重并发症发生。术后标本及病理证实输尿管结石8例，UPJ梗阻14例。结论：经皮肾镜下将肾积水吸出后可明显扩大腹膜后腔，使后腹腔镜下切除巨大积水肾脏更为安全、方便。

Objective： To investigate the clinical significance of patients with giant hydronephrosis treated by percutaneous nephroscope set combined retroperitoneal laparoseopic nephrectomy.Method： 22 patients with giant hydronephrosis were reviewed.All of them were diagnosed by CTU and ECT.The renal cortex was thin and the GFR was 0-3 ml/min in the affected side kidney.The uninjured side kidney had good visualization in CTU and the GFR was 55-95 ml]min.The total renal function was normal level.8 cases of them were injured by upper ureteric calculus, and 14 cases were diagnosed preliminarily UPJ obstruction.All the patients were treated by percutaneous nephroscope set to draw off the water and then completed the surgeon of retroperitoneal laparoscopic nephrectomy.Result： All procedures were successfully completed without the need for conversion to open surgery.The mean operating time was 95 minutes（range 75 to 125 min）.None of them had major complication intraoperatively or postoperatively.The etiology was confirmed by pathology postoperative that 8 cases were upper ureteric calculus and 14 patients were UPJ obstruction.Conclusion： Using the percutaneous nephroscope set to draw off the water to enlarge the retroperitoneal space can be more safely and conveniently in the treatment of retroperitoneal laparoscopie nenhrectomv for natients with giant hvdronenhrosis.