后腹腔镜肾切除术治疗无功能积水、萎缩肾

Treatment of non-functional hydronephrosis or atrophy kidney with retroperitoneal laparoscopic nephrectomy

目的：探讨后腹腔镜肾切除术治疗无功能积水、萎缩肾的技术要点及手术方法。方法：回顾分析2012年4月至2014年10月为24例无功能积水、萎缩肾患者行后腹腔镜肾切除术的临床资料,观察手术时间、术中出血量、感染情况。结果：23例手术获得成功,1例中转开放手术。手术时间60-220 min,平均（103.0±35.1）min;出血量20-250 ml,平均（45.3±31.7）ml。术后均无肾周、切口感染发生,其中1例肾盂输尿管癌患者术后3个月发生肿瘤皮下种植。结论：由于积水肾、萎缩肾使肾动脉定位寻找游离难度大,术中先于肾周筋膜下游离肾脏,再游离结扎肾动静脉是安全、可靠的手术方法。腹腔镜肾切除术容易引起肾破裂,因此对于肾结核或肾盂、输尿管肿瘤导致的积水或萎缩肾,应行开放性肾切除术。

Objective： To investigate major skills and methods in treating non-functional hydronephrosis or atrophy kidney with retroperitoneal laparoscopic nephrectomy. Methods： The clinical data and postoperative conditions of 24 patients with non-functional hydronephrosis or atrophy kidney who received retroperitoneal laparoscopic nephrectomy from Apr. 2012 to Oct. 2014 were retrospectively analyzed,the operation time,blood loss and the incidence of infection were observed. Results： Operations were successfully performed in23 patients,one patient was converted to open surgery. Operation time of patients with retroperitoneal laparoscopic nephrectomy was 60-220 min with the average of（ 103. 0 ± 35. 1） min; blood loss was 20-250 ml,（ 45. 3 ± 31. 7） ml in average. No perinephric tissue or wound infection was found after the surgery. 1 case with renal pelvic and ureteral cancer was found subcutaneous implantation in 3months after operation. Conclusions： It is a comparatively safe and reliable method to locate,identify,isolate and ligate renal artery and vein after complete isolation of kidney by dissection under perirenal fascia,due to renal artery location and dissociation being very difficult in non-functional hydronephrosis or atrophy kidney. Laparoscopic nephrectomy can easily lead to renal crack,so hydronephrosis or atrophy kidney caused by renal tuberculosis and renal pelvic or ureteral tumor should take open nephrectomy.