后腹腔镜包膜下肾切除术治疗严重感染粘连性无功能肾(附12例报告)

Retroperitoneoscopic subcapsular nephrectomy for infective nonfunctioning kidney with dense perinephric adhesion(report of 12 cases)

目的 探讨后腹腔镜包膜下肾切除术治疗严重感染粘连性无功能肾的技术方法和临床应用价值。 方法 12例患者 ,男 8例 ,女 4例。年龄 35～ 6 6岁 ,平均 4 1岁。肾结核 5例 ,肾急慢性感染 7例 ,其中肾积脓行肾穿刺造瘘或输尿管插管引流术后 6例。左侧 7例 ,右侧 5例。 12例患者均行后腹腔镜包膜下肾切除术。沿肾脏长轴切开增厚的肾包膜 ,肾包膜内游离肾实质 ,紧靠肾门处再次环形切开肾包膜 ,分离肾血管周围脂肪 ,使肾蒂组织薄到足以用直线切割吻合器离断 ,再离断肾蒂 ,切取肾脏 ,留置腹膜后引流管。观察手术时间、术中出血量、术后肠功能恢复和术中、术后并发症及手术效果。 结果 12例手术均获成功 ,无中转开放。手术时间 (82 .9± 2 2 .3)min ,术中出血量 (5 1.4± 12 .2 )ml,术后肠功能恢复时间 2 4～ 4 8h ,术后平均住院时间 7.5d ,术中及术后无明显并发症。随访 1～15个月 ,效果满意。 结论 该术式具有微创、出血少、恢复快、近期效果好等特点 ,较好地解决了感染性无功能肾脏与周围组织粘连严重时后腹腔镜肾切除的难题。但手术操作难度较大 ,术者需具备一定的腹腔镜手术经验。

Objective To evaluate the technical feasibility and clinical efficacy of retroperitoneoscopic subcapsular nephrectomy in the management of infective non-functioning kidney. Methods Twelve patients (8 males and 4 females) were included.Their mean age was 41 years (range,35 to 66 years).Of the 12 cases,5 had tuberculous pyonephrosis and 7 had acute or chronic infective pyonephrosis.Of them,6 had undergone pyelostomy previously.Of the 12 cases,7 had the diseased kidneys on left side and 5 on right side.Retroperitoneoscopic subcapsular nephrectomy was performed in all of them.The operating time,blood loss,postoperative intestinal function recovery,intraoperative and postoperative complications and the operative efficacy were observed. Results All the operations were performed successfully.None of the cases experienced conversion to open surgery.The operating time was (82.9±22.3)min;the blood loss volume was (51.4±12.2)ml and postoperative intestinal function recovery time was 24 to 48 h.The mean hospital stay after operation was 7.5 days.No complication occurred during and after operation.Follow-up of 1 to 15 months showed satisfactory effects. Conclusions This procedure is characterized by microtrauma,less blood loss,quicker recovery and better short-term effects.Furthermore,it can overcome the difficulty of retroperitoneoscopic dissection and removal of infective non-functioning kidney that is tightly adhesive to surrounding tissues.However,as a complicated and challenging surgical procedure,it needs more experience in laparoscopic techniques.