无功能肾后腹腔镜下个体化手术的临床体会(附84例报告)

Individual strategy of retroperitoneoscopic nephrectomy for benign non-functioning kidneys(84 cases)

目的探讨后腹腔镜下不同解剖层面无功能肾切除的手术方法及临床疗效。方法回顾性分析2010年2月-2016年11月84例良性无功能肾患者临床资料。根据病因、影像及层次特点分别按3个不同解剖层面行后腹腔镜下肾切除,层面为:贴Gerota's筋膜内切除组(A组)、包膜外切除组(B组)、包膜内切除组(C组)。收集3组患者的临床资料及围手术期数据进行统计学分析。结果 C组手术时间及失血量明显大于A、B两组,差异有统计学意义(P<0.05),住院时间、并发症、恢复时间组间差异无统计学意义(P>0.05);结核与非特异性感染病例手术时间与失血量大于其他病例组,差异有统计学意义,余数据差异无统计学意义;84例均在后腹腔镜下获成功,术后1例切口感染,随访6~84个月恢复良好。结论感染性疾病肾周存在的粘连最为严重,包膜内肾切除手术复杂但为严重粘连肾切除的最佳术式,选择正确的相对无血管层面是手术成功的关键。

Objective To explore the technique and clinical efficacy of retroperitoneoscopic nephrectomy(RN)at different anatomical plane for benign non-functioning kidneys.Method We retrospectively reviewed the clinical data of84patients who underwent RN for benign non-functioning kidneys from February2010to November2016.Various anatomical plane was performed for differing etiology,image and plane,included radical nephrectomy(A group,n=35),simple nephrectomy(B group,n=27)and subcapsular nephrectomy(C group,n=22).Clinical data and preoperative information was collected and analyzed.Result Nephrectomy was performed successfully in84patients.There are significantly longer mean operative time and more estimated blood loss in the C group than that in A group and B group(P<0.05),however,postoperative hospital stay,complications and recovery time were significantly less in the three groups.There was longer mean operative time and more estimated blood in specific and nonspecific infection group compared with the other two groups(P<0.05).Conclusion Retroperitoneoscopic nephrectomy,although challenging,is safe,reliable,and successful for treatment of benign non-functioning kidneys.Anatomical plane of avascular zone should be offered as the choice of modality to all patients with benign nonfunctioning kidney.