180例后腹腔镜下肾上腺及上尿路疾病治疗分析

Clinical analysis of retroperitoneal laparoscopic surgery for adrenal gland and upper urinary tract diseases:A report of 180 cases

目的总结后腹腔镜下肾上腺、肾及输尿管疾病治疗的临床经验和手术技巧,通过总结后腹腔镜技术特点进而提高后腹腔镜技术水平,推进腹腔镜技术在基层医院的普及和发展。方法对亳州市人民医院2011年1月—2015年4月收治的泌尿外科疾病患者中抽取180例作为研究对象,其中肾囊肿去顶减压术60例,肾上腺疾病手术11例(嗜铬细胞瘤1例、神经纤维瘤3例、无功能肾上腺囊肿6例、皮质增生1例)、单纯性肾切除30例,肾癌根治性切除术15例,肾部分切除术4例,输尿管切开取石术60例。观察手术时间、出血量、住院时间、住院费用等。结果本组180例,177例在后腹腔镜下顺利完成手术,肾上腺疾病11例,平均手术时间91 min,出血量平均16 ml。肾囊肿60例、平均手术时间35 min,出血量平均10 ml,单纯性肾切除30例,平均手术时间120 min,出血量平均20 ml。肾癌手术(包括肾癌根治性切除术15例,肾部分切除术4例)平均手术时间126 min,出血量平均25 ml,输尿管切开取石术60例。平均手术时间100 min,出血量平均15 ml。3例中转开放,无严重并发症发生,疗效满意。结论后腹腔镜下肾上腺、肾及输尿管疾病手术在基层医院也可成功开展、也易为患者接受,值得临床大力推广。

Objective To summarize the clinical experience and surgical technique of retroperitoneal laparoscopic man- agement of adrenal gland, renal and upper urinary tract diseases,improve the technical level, and promote the populariza- tion laparoscopic techniques in primary level hospitals. Methods The clinical data of one hundred and eighty patients with urological diseases undergoing retroperitoneal laparoscopic surgery in our hospital between January,2011 and April, 2015 were analyzed respectively. There were 60 cases of renal cyst decortication, 11 cases of adrenal disease surgery （ 1 case of pheochromocytoma,3 cases of neurofibroma,6 cases of nonfunctional adenoma, 1 case of adrenal cortical hyperpla- sia） ,30 cases of simple nephrectomy, 15 cases of radical nephrectomy,4 cases of partial nephrectomy, 60 cases of uret- erolithotomy. To operation time, amount of blood loss, length of stay, hospital expenses, etc. Results Of the 180 cases, 177 eases accomplished retroperitoneal laparoscopic surgery and 3 cases converted to open surgery. For the 11 cases of ad- renal gland disease,the average operation time was 91 min, the amount of blood loss was 16 ml;for 60 cases of renal cyst decortication, the average operation time was 35 min ,the average blood loss was 10 ml ;for 30 cases simple nephrectomy, the average operation time was 120 min,the average blood loss was 20 ml;for 19 cases of kidney cancer surgery（ 15 cases of radical nephrectomy,4 cases partial nephreetomy） ,the average operation time was 126 min,the average blood loss was 25 ml;for 60 eases of ureterolithotomy, the average operation time was 100 min, the average blood loss was 15 ml. There was no severe complication and therapeutic efficacy was satisfactory. Conclusion The retroperitoneal laparoscopic sur- gery for adrenal gland and upper urinary tract diseases can be widely applied in basic-level hospitals.