完全性后腹腔镜下肾输尿管全长切除术治疗肾结核的临床体会

Total retroperitoneal laparoscopic nephroureterectomy for tuberculous nonfunctional kidney

目的探讨完全性后腹腔镜下肾输尿管全长切除术治疗肾结核的可行性和安全性。方法选取该院2013年1月-2016年1月收治的肾结核病患者15例。其中,男12例,女3例,年龄36~64岁,平均47岁。所有患者根据病史、症状及术前辅助检查,包括经尿找抗酸杆菌、静脉尿路造影、CT等均确诊为肾结核,且经核素肾图检查明确为单侧结核性无功能或功能严重受损肾脏,对侧肾功能正常。术前常规给予三联抗结核药物治疗至少4周,确认无活动性肾外结核,红细胞沉降率恢复正常后行后腹腔镜下肾输尿管全长切除术,利用结扎夹或内镜用切割缝合器处理输尿管末端,实行患者不翻身情况下完全切除患侧肾及输尿管全程。结果 15例手术均获成功,无中转开放病例。手术时间75~138 min,平均109 min;术中出血量70~230 ml,平均157 ml;术后住院5~11 d,平均7 d。术中损伤肾静脉、腰静脉各1例,输尿管末端破裂1例,损伤腹膜3例,未出现术后切口感染及出血等并发症。术后继续抗结核治疗至少5个月,随访25个月,未发现结核复发病例,所有患者的尿路刺激症状消失,经尿找抗酸杆菌阴性,红细胞沉降率正常,复查B超未发现泌尿系统结核病灶残留。结论通过上述方法施行完全性后腹腔镜下肾输尿管全长切除术,无需改变患者体位及增加开放切口,创伤小,恢复快,安全可行。

Objective To evaluate the safety and feasibility of total retroperitoneal laparoscopic nephroureterectomy for a tuberculous non-functional kidney.Methods A total of15individuals diagnosed with unilateral non-functional kidney secondary to tuberculosis were encountered from January2013to January2016.There were12male and3female patients with an average age of47(range36~64years old)in the cohort.All patients had normal renal function on the contralateral side and underwent the standard three-drug antituberculosis treatment for at least four weeks before surgery.Total retroperitoneal laparoscopic nephroureterectomy was performed in all patients,and the enlarged section of the distal ureter was managed using different auto-suture techniques.Results All the operations were successfully performed without conversion.The median operative time was109min(range,75~138min),the median blood loss was157ml(range,70~230ml),and the median hospitalization time was7days(range,5~11days).Renal vein injury,lumbar vein injury and rupture of distal ureter occurred in1patient,respectively.Peritoneum injury was observed in3patients.No serious perioperative complications occurred.Anti-tuberculosis chemotherapy was prescribed to all patients,with the entire course of treatment lasting five months.No recurrence of tuberculosis of the bladder or the contralateral kidney was observed during the median follow-up period of25months.Conclusion Total retroperitoneal laparoscopic nephroureterectomy is a safe and feasible approach for the treatment of tuberculous non-functional kidneys,and it is minimal and rapid recuperation.