Robotic-assisted retroperitoneal lymph node dissection for stage II testicular cancer

Objective:To evaluate the perioperative as well as early oncological outcomes of patients undergoing robotic retroperitoneal lymph node dissection for treatment of testicular cancer.Methods:We conducted a prospective consecutive case series of patients undergoing robotic assisted retroperitoneal lymph node dissection for metastatic testicular cancer between May 2018 and July 2021 at our institution.Data were collected on patient and tumour characteristics,intraoperative and postoperative parameters,and functional and oncological outcomes.Descriptive statistics are presented.Results:Nineteen patients were identified;18(94.7%)completed the procedure robotically and one was converted to open surgery;78.9%of patients had stage≥IIB and 12(63.2%)patients had undergone prior chemotherapy.The median operative time was 300(interquartile range[IQR]240-315)min.Median blood loss was 100(IQR 50-175)mL.Median length of stay was 2(range 1-11)days.All robotically completed patients commenced diet and passed flatus on Day 1 and were discharged by Day 3.The median lymph node yield was 40.5(IQR 38-51)nodes.All patients undergoing nerve-sparing procedures recovered antegrade ejaculatory function.One patient had a Clavien-Dindo III complication(chylous ascites requiring drainage).At a median follow-up of 22.3(IQR 16.3-24.9)months,one patient developed retroperitoneal recurrence,which was successfully treated with second-line chemotherapy;no other patients have had recurrences.Conclusion:Robotic retroperitoneal lymph node dissection is a safe and feasible alternative to open surgery in appropriately selected patients,offering low morbidity.Early oncological outcomes are promising.Larger cohorts and longer follow-ups are required to validate our institution's findings.

Retroperitoneal bronchogenic cyst:A case report and review of literature

BACKGROUND Bronchogenic cysts are rare developmental anomalies that belong to the category of congenital enterogenous cysts.They arise from lung buds and are present at birth.The embryonic foregut is their origin.Typically,they are located within the chest cavity,particularly in the cavum mediastinale of the thoracic cavity or lodged in the pulmonary parenchyma,and are considered a type of lung bud malformation.CASE SUMMARY A 49-year-old male patient was admitted to the hospital due to the detection of a retroperitoneal mass during a physical examination.Two weeks before admission,the patient underwent a physical examination and routine laboratory tests,which revealed a space-occupying mass in the retroperitoneal region.The patient did not report any symptoms(such as abdominal pain,flatulence,nausea,vomiting,high fever,or chills).The computed tomography(CT)revealed a retroperitoneal spaceoccupying lesion with minimal enhancement and a CT value of approximately 36 Hounsfield units.The lesion was not delineated from the boundary of the pancreatic body and was closely related to the retroperitoneum locally.CONCLUSION Following a series of tests,an abdominal mass was identified,prompting the implementation of a laparoscopic retroperitoneal mass excision procedure.During the investigation,an 8 cm×7 cm cystic round-shaped mass with a distinct demarcation was identified in the upper posterior region of the pancreas.Subsequently,full resection of the mass was performed.Postoperative pathological examination reveled a cystic mass characterized by a smooth inner wall.The cystic mass was found to contain a white,viscous liquid within its capsule.

Devascularization of the superior mesenteric vein without reconstruction during surgery for retroperitoneal liposarcoma: A case report and review of literature

A 61-year-old female patient with chronic hepatitis B virus infection was diagnosed with liposarcoma in a community hospital. Fine needle aspiration biopsy confirmed the diagnosis of well-differentiated liposarcoma. Abdominal computed tomographic angiography(CTA) showed that the mass adhered to and constricted the main trunk and branch of the superior mesenteric vein(SMV), especially the ileocolic vein, and collateral circulation was observed during the vascular reconstruction scan. The abdominal liposarcoma was resected. Because of the collateral circulation, devascularization of the SMV was attempted, and we resected the eroded SMV. The condition of the blood vessels was evaluated 20 d after surgery using CTA, which showed that the SMV had disappeared. Significant improvements in SMV collateral circulation and the inferior mesenteric vein were observed after vascular reconstruction. The patient had an uneventful postoperative course except for transient gastroplegia. Twenty months after surgery, the patient had a recurrence of liposarcoma. She underwent tumor resection to remove the distal small intestine and right hemicolon. We learned that(1) direct devascularization of the main SMV trunkwithout a vein graft is possible. The presence of collateralcirculation can increase the success rate of patientsundergoing radical surgery and prevent the occurrence ofserious postoperative complications. In addition,(2) thiscase demonstrated the clinical value of 3 D reconstruction.

Massive retroperitoneal hematoma as an acute complication of retrograde intrarenal surgery:A case report

BACKGROUND Retrograde intrarenal surgery(RIRS)has been proven to be a safe and effective treatment modality in large-scale quantitative studies.However,although its safety profile has been established,it also has a potential risk of life-threatening complications.We here describe our experience with a patient who developed a huge periureteral hematoma after RIRS with holmium laser lithotripsy.CASE SUMMARY A 73-year-old woman visited our center with a complaint of gross hematuria.An enhanced computed tomography(CT)scan revealed a 1.5-cm left renal pelvis stone with hydronephrosis.The patient underwent RIRS.During the surgery,a 12/14-Fr ureteral access sheath was applied and a 6-Fr ureteral catheter was indwelled thereafter.On postoperative day 1,she experienced aggravated left flank pain and left lower-quadrant tenderness without rebound tenderness.A follow-up CT scan was taken,which revealed a huge hematoma in the periureteral space,not in the perirenal space,with suspicious contrast medium extravasation.Immediate angiography was performed;however,it showed no evidence of active bleeding.She was conservatively managed with hydration and antibiotic and nonsteroidal anti-inflammatory drug therapy,and was discharged on postoperative day 7.However,she visited our outpatient department with recurrent left flank pain at 5 d from discharge.Ultrasonography confirmed that the double J-stent was intact.To rule out stent malfunction,the stent was changed.Decreased size of the hematoma was observed in the imaging studies,and conservative management for candiduria was performed for 1 wk.CONCLUSION Although RIRS is an effective and safe procedure for the management of renal stones,clinicians should be aware of its potential complications.

Retroperitoneal paragangliomas:Report of 4 cases

We reviewed the data of all patients managed for retroperitoneal paragangliomas(PGLs)between June 2010and June 2011 to present our experience concerning this uncommon entity to highlight diagnostic and therapeutic challenges of retroperitoneal PGLs.All patients were admitted to the department of general and hepatobiliary surgery in the regional hospital of Jendouba,Tunisia.The size of the tumor was taken at its largest dimension,as determined in a computed tomography(CT)scan and pathological reports.There were 4 patients(all women)with a median age of 48 years(range46-56 years).Abdominal pain was the commonest presentation.CT showed and localized the tumors which were all retroperitoneal.All patients had successfu surgical resection of the tumors under invasive arterial blood pressure monitoring.One patient underwent surgery for a presumed tumor of the pancreatic head.The fresh-mount microscopic study of the peroperative biopsy yielded inflammatory tissue without malignancy and no resection was performed.Final histologica examination of the biopsy concluded PGL.A secondlaparotomy was performed and the tumor was entirely resected.The diagnosis was made after surgery by histology in all patients.The control of the blood pressure was improved after surgery in 3 patients.Paragangliomas are rare tumors.The retroperitoneal localization is uncommon.Complete surgical resection remains the only curative treatment but it is often challenging as these tumors are located near multiple vital blood vessels.

Retroperitoneal congenital epidermoid cyst misdiagnosed as a solid pseudopapillary tumor of the pancreas:A case report

BACKGROUND Retroperitoneal cysts are rare and usually asymptomatic abdominal lesions.Epidermoid cysts are frequent benign cutaneous tumors,but retroperitoneal localization of these cysts does not occur very often.CASE SUMMARY We report a case report of a 25-year-old woman with a giant mass in the abdominal cavity.Because imaging examination indicated that the mass probably originated from the pancreas,the mass was considered a solid pseudopapillary tumor of the pancreas(SPTP).However,surgery revealed a retroperitoneal epidermoid cyst located behind the pancreas neck and the root of the superior mesenteric artery(SMA).We performed complete resection of the tumor.Postoperative pathology showed an epidermoid cyst.The patient fared well after two months of follow-up.CONCLUSION Surgery is the gold standard for the diagnosis and treatment of retroperitoneal epidermoid cysts.Retroperitoneal epidermoid cysts around the pancreas are easily misdiagnosed as cystic SPTPs.Surgeons should pay particular attention to preoperative diagnosis to reduce severe surgical complications and improve the quality of life of patients.

Retroperitoneal fibrosis: A rare cause of both ureteral and small bowel obstruction

Retroperitoneal fibrosis (RPF) is a rare condition of unclear etiology. It can cause ureteral obstruction. We present the unique case of a 54 years old female, who initially presented with spontaneous perforation of the cecum. Upon exploring the abdomen, the classical glistening white, unyielding retroperitoneal fibrosis was encountered. A right hemicolectomy was performed. Subsequently, the patient presented with bilateral ureteral obstruction, and later on with small bowel obstruction. Ureteral obstruction was treated with stents, and small bowel obstruction was treated with bypass. To our knowledge no case of idiopathic RPF presenting with features of both bilateral ureteral and small bowel obstruction has been reported in the literature.

Laparoscopic retroperitoneal lymph node dissection versus open retroperitoneal lymph node dissection for testicular cancer:A comparison of clinical and perioperative outcomes

Objective:This study was performed to evaluate the clinical and perioperative outcomes of laparoscopic retroperitoneal lymph node dissection(L-RPLND)and open retroperitoneal lymph node dissection(O-RPLND)performed by one surgeon at a single center.Methods:We evaluated 30 patients with stage IIA germ cell tumors who underwent retroperitoneal lymph node dissection(15 underwent L-RPLND and 15 underwent O-RPLND)at our institution between April 1,2010 and March 31,2018.The clinical parameters were compared between patients who underwent L-RPLND using the retroperitoneal approach and those who underwent O-RPLND using the transperitoneal approach.There were no significant differences in the background characteristics of the two groups except for the median follow-up duration(46 months for L-RPLND and 71 months for O-RPLND,p=0.02).Results:L-RPLND was associated with a shorter mean operative time(mean 222 min for L-RPLND vs.453 min for O-RPLND,p<0.001).There was significantly less blood loss during surgery in the L-RPLND group compared to the O-RPLND group(mean 165 mL for L-RPLND vs.403 mL for O-RPLND,p<0.001).Parameters related to postoperative recovery were significantly better for the L-RPLND group than for the O-RPLND group.There were no differences in the histopathological characteristics between the two groups.No patients in either group exhibited disease recurrence.Conclusion:Patients who underwent L-RPLND had more rapid recovery,and shorter hospital stay compared to those who underwent O-RPLND;complications were comparable between the two groups.L-RPLND is an efficient procedure with the benefits of minimally invasive surgery.

Successful robot-assisted partial nephrectomy for giant renal hilum angiomyolipoma through the retroperitoneal approach: A case report

BACKGROUND Giant renal angiomyolipomas(AMLs)may lead to complications including flank pain,hematuria,hypertension,retroperitoneal hemorrhage and even death.Giant AMLs which grow around renal hilar vessels and the ureter are rare.Most previous reports on the treatment of giant renal AMLs have focused on open surgery or a transperitoneal approach,with few studies on the retroperitoneal approach for large AMLs.We here report a case of giant renal hilum AML successfully treated with robot-assisted laparoscopic nephron sparing surgery the retroperitoneal approach,with a one-year follow-up.CASE SUMMARY A 34-year-old female patient was diagnosed with renal AML 11 years ago and showed no discomfort.The tumor gradually increased in size to a giant AML over the years,which measured 63 mm×47 mm×90 mm and was wrapped around the right hilum.Therefore,a robotic laparoscopic partial nephrectomy(LPN)via the retroperitoneal approach was performed.The patient had no serious postoperative complications and was discharged soon after the operation.At the one-year follow-up,the patient's right kidney had recovered well.CONCLUSION Despite insufficient operating space via the retroperitoneal approach,LPN for giant central renal AMLs can be completed using a well-designed procedure with the assistance of a robotic system.

Retroperitoneal teratoma resection assisted by 3-dimensional visualization and virtual reality:A case report

BACKGROUND Primary retroperitoneal tumor is a rare type of tumor with insidious onset,large tumor size at the time of diagnosis,and often extensive involvement of surrounding tissues and blood vessels in the retroperitoneum.Surgery for primary retroperitoneal tumors is technically challenging.Preoperative imaging evaluation is critical for the selection of the optimal surgical approach and can influence complete resection and recurrence rates.Three-dimensional model reconstruction combined with virtual reality is useful for preoperative assessment.CASE SUMMARY A 17-year-old female patient was admitted for abdominal pain lasting for half a year that had been worsening for half a month.Abdominopelvic enhanced helical computed tomography revealed a retroperitoneal space-occupying lesion about 11.3 cm×9.1 cm in size,with well-defined borders in the upper left quadrant of the abdomen.The lesion compressed the left renal artery and vein resulting in vascular displacement and deformation.A multidisciplinary team decided on the optimal treatment approach.Preoperative three-dimensional visualization and virtual reality technology were used to assess and simulate the surgical procedure.Then,retroperitoneal tumor resection along with renal artery reconstruction was decided as the treatment.Complete resection of the retroperitoneal tumor was performed.Stable blood flow was established after renal artery reconstruction.The tumor was diagnosed as mature cystic teratoma(retroperitoneal tumor)by postoperative pathologic analysis.The patient,who recovered well,was discharged after 2 wk and maintains regular follow-ups.CONCLUSION A combination of three-dimensional reconstruction and virtual reality technology before surgery improves the rate of complete resection of retroperitoneal teratoma.

Giant retroperitoneal malignant schwannoma:A case report and review of literature

The retroperitoneal malignant schwannoma is an extremely rare pathological entity and sparsely reported in the literature.We reported a case of a 56-year-old man who was admitted to our hospital for giant retroperitoneal malignant schwannoma with 40 cm in diameter.The case did not accompanied by neurofibromatosis.We used spiral CT 3D reconstruction to identify the characters of the tumor and the invasion to the peripheral organs before surgery.The patient has been survived for more than 8 years after radical surgery.Its clinical presentation, radiological, histopathological features, and radical surgery were retrospective analysis.

Natural orifice transluminal endoscopic surgery:The transvaginal route moving forward from cholecystectomy

The advent of minimally invasive surgery and the advances in endoluminal flexible endoscopy have converged to generate a new concept in digestive surgery,whose acronym natural orifice transluminal endoscopic surgery(NOTES),has become a familiar term in the surgical community.NOTES has been performed through the mouth,the bladder,the rectum and the vagina.Of these four approaches,the vagina has gained most popularity for several reasons.It is not only readily accessible and easy to decontaminate but it also provides safe entry and simple closure.The transvaginal approach has been described in the experimental and the clinical setting as an option for cholecystectomy,nephrectomy,splenectomy,segmental gastrectomy,retroperitoneal exploration and bariatric surgery.However,larger series are needed to delineate the exact risks of this approach,and to transcend cultural barriers that impede its wider introduction.Prospective randomized trials will shed light on the definitive role of the vaginal approach in minimal invasive surgery of the future.

Appendicitis with psoas abscess successfully treated by laparoscopic surgery

Although acute appendicitis is a common disease, retroperitoneal abscesses are rarely observed. Here, we report a case consisting of a psoas abscess and cutaneous fistula caused by appendicitis. The patient was a 56-year-old male who was introduced to our institution due to an intractable right psoas abscess. Imaging tests had been performed over the previous 3 years; however, clinicians could not find the origin of the abscess and failed to resolve the problem. A successful operation was performed via a laparoscopic approach, and 17 mo have passed without recurrence. The advantage of laparoscopic surgery is well understood in cases of appendicitis with abscesses. However, the indication for laparoscopic approach is not clear for retroperitoneal abscesses. From our experience, we can conclude that appendicitis with retroperitonealabscesses can be managed and treated using a laparoscopic approach.

后腹腔镜供肾取肾术与开放取肾术式临床效果对比分析

目的探讨后腹腔镜供肾取肾术与开放取肾术式临床效果优劣。方法回顾性分析2023年1月至2024年4月亲属供肾者的临床资料,男性46例,女性93例,平均年龄为(54.21±6.52)岁。采用后腹腔镜取肾术式99例,采用开放取肾术式40例。收集供肾者既往史、肾脏位置、供肾动脉长度、肾脏维度、动脉支数、手术时间、术中出血量、手术切口长度、术后最高肌酐、术后最高尿素氮、术后住院天数、术后总引流量、供肾取下后动脉长度、热缺血时间、术中腹膜破损及脂肪粘连、并发症情况资料进行分析。结果腹腔镜组手术切口较开放术式组明显缩小、出血量及术后引流量明显减少、供者住院天数明显缩短(P<0.05),热缺血时间较开放术式组明显延长(P<0.05)。男性、体质量指数大、既往吸烟史、外伤史、肾脏维度大、术中出血多、腹膜破损及脂肪粘连会显著增加手术时间(P<0.05)。结论腹腔镜术式在亲属活体供肾取肾术中,在保证肾脏质量前提下,没有延长手术时间,同时具有切口小、出血少、供者恢复快等优点。

加速康复外科在肾上腺肿瘤微创手术中的应用研究

目的探讨加速康复外科(ERAS)应用于肾上腺肿瘤微创手术中的可行性和有效性。方法选择接受后腹腔镜肾上腺肿瘤切除术的患者139例,肿瘤最大径≤6.0 cm。根据围手术期方案分为ERAS组65例和常规组74例。比较2组患者一般资料(年龄、性别、肿瘤位置、肿瘤直径),手术指标(手术时间、手术出血量),术后康复指标(首次下床时间、首次排气时间、术后导尿管留置时间、术后引流管留置时间、术后住院时间)以及并发症的发生情况。结果2组患者性别、年龄、肿瘤位置、肿瘤直径、手术时间和手术出血量比较差异均无统计学意义(P>0.05)。ERAS组患者首次下床时间、首次排气时间、导尿管留置时间、引流管留置时间和住院时间均短于常规组,且术后并发症总发生率低于常规组(P<0.05)。结论ERAS方案应用于肿瘤最大径≤6.0 cm的肾上腺肿瘤患者微创手术中是安全可行的。

肾周粘连脂肪评分对后腹腔镜肾上腺切除术路径选择的影响

目的评估采用经脂肪囊外路径或经肾周脂肪囊内路径的后腹腔镜肾上腺切除(RLA)术治疗肾上腺良性肿瘤的效果,并基于肾周粘连脂肪(MAP)评分探讨手术路径的选择。方法回顾性分析2015年2月—2020年12月在西安交通大学第一附属医院接受RLA手术治疗的102例肾上腺良性肿瘤患者的临床资料,通过断层影像资料计算MAP评分,比较采用经脂肪囊外路径(经典组,n=56)或经肾周脂肪囊内路径(改良组,n=46)的患者围手术期各项数据及经MAP评分分层后手术结果的差异。结果所有患者手术均成功施行,无中转开放或需输血者。两组手术时间[(102.1±26.3)min vs.(110.2±32.1)min,P=0.17]、术中出血量[(53.5±34.0)mL vs.(61.1±48.4)mL,P=0.35]间的差异无统计学意义。基于MAP评分的亚组分析显示,在低风险亚组(MAP评分0~2分)中,两种不同路径手术的上述指标无显著差异,而在高风险亚组(MAP评分3~5分)患者中,采用经脂肪囊外路径(经典组)的手术时间更短[(114.7±20.7)min vs.(137.2±23.0)min,P<0.01],术中出血量也更少[(52.7±33.1)mL vs.(92.8±49.7)mL,P=0.01]。结论通过两种手术路径进行RLA术均安全可行。MAP评分系统可作为术前路径规划的有效工具,对于高MAP评分(3~5分)的患者,采取经脂肪囊外路径可能手术时间较短且出血量较少。

90°斜侧卧位在后腹腔镜下泌尿外科手术中应用的效果观察

目的探讨90°斜侧卧位在后腹腔镜下泌尿外科手术中的应用效果,为临床提供一种有效降低皮肤压力性损伤发生率的手术体位。方法回顾性分析2023年9月至12月于本院泌尿外科收治的60例计划接受后腹腔镜手术的泌尿科患者,根据手术体位的不同,将患者分为对照组与试验组,每组分别30例。对照组患者采用传统90°正侧卧位实施手术,试验组患者采用90°斜侧卧位实施手术。比较两组患者术后受压部位皮肤压力性损伤发生率、术后24h腰背部疼痛程度、手术操作者的满意度评分。结果两组患者术后受压部位皮肤压力性损伤发生率、术后24h腰背部疼痛程度、手术操作者的满意度评分比较,均P<0.05,差异具有统计学意义,试验组患者术后受压部位皮肤压力性损伤发生率低于对照组,疼痛程度轻于对照组,手术操作者满意度评分高于对照组。采用Logistic回归分析控制人口学变量后两组患者术中压力性损伤发生风险结果显示,对照组发生风险是试验组的6.22倍。结论在后腹腔镜下泌尿外科手术中,采用90°斜侧卧位优于90°正侧卧位,可有效降低患者术中压力性损伤的发生率与减轻术后腰背部疼痛程度。

腹腔镜下保留肾单位手术与后腹腔镜肾癌根治术对非晚期肾癌患者免疫功能的影响

目的对比腹腔镜下保留肾单位手术(LNSS)与后腹腔镜肾癌根治术(RLRN)治疗非晚期肾癌患者的效果及对免疫功能的影响。方法回顾性收集商丘市第三人民医院2020-04—2023-04收治的150例非晚期肾癌患者的病例资料,按手术方案不同分为2组。行LNSS治疗的75例患者列为A组,行RLRN治疗的75例患者列为B组。对比2组手术指标,手术前后血尿素氮(BUN)、血肌酐(Scr)、明胶酶相关脂质运载蛋白(NGAL)肾功能,欧洲癌症研究与治疗组织生命质量测定量表(EORTC QOL-C30)评分,免疫功能(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))水平,并发症发生率。结果A组术中失血量少于B组,术后第3天时的BUN、Scr、NGAL水平低于B组,CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平高于B组,术后禁食时间及住院时间短于B组,差异均有统计学意义(P<0.05);A组术后3个月时的EORTC QOL-C30评分高于B组,并发症发生率低于B组,差异有统计学意义(P<0.05)。结论与RLRN治疗非晚期肾癌患者比较,经LNSS治疗有助于减少术中出血量,降低并发症发生风险,缩短患者康复进程,提升生活质量,且对机体肾功能、免疫功能造成的影响较小。

两种不同术式治疗肾囊肿的临床疗效对比研究

对比分析后腹腔镜肾囊肿去除术和肾囊肿开窗术治疗肾囊肿的临床疗效。选取2022年4月—2023年6月盘州市人民医院收治的30例肾囊肿患者为研究对象,所有患者均接受手术治疗,观察组(n=15)患者接受后腹腔镜肾囊肿去除术治疗,对照组(n=15)患者接受肾囊肿开窗术治疗。比较两组患者治疗效果。结果显示,观察组手术出血量更少,手术用时和住院时间更短(P<0.05);观察组患者并发症总发生率低于对照组(P<0.05);治疗后,观察组患者应激反应指标优于对照组(P<0.05)。研究发现,后腹腔镜肾囊肿去除术在治疗肾囊肿时,能有效减少对患者机体的损伤,可降低患者总出血量,缩短手术操作时间,减少感染等并发症的发生,促进患者尽快康复,临床应用价值较高。

腹膜后入路腹腔镜下手术治疗腰椎结核

目的：总结腹膜后入路腹腔镜下手术治疗腰椎结核的疗效。方法：2009年10月～2011年10月采用腹膜后入路腹腔镜下手术治疗腰椎结核患者16例，男11例，女5例，年龄26～62岁，平均38．2岁。L1～L22例，L2～L35例，L3－L4 4例，L2－L4 2例，L3～L5 1例，L3 1例，L4 1例；均有椎旁脓肿，单侧12例，双侧4例。12例合并腰椎后凸畸形，Cobb角5~-20。，平均11．2°±3．6°。神经功能受损2例，ASIA分级C级1例，D级1例。均采用腹膜后入路，其中4例双侧脓肿选择左侧入路，12例单侧脓肿选择脓肿侧入路。5例破坏L1或椎体破坏超过50％患者，采用传统腹腔镜技术操作，行前路单纯病灶清除及植骨，联合后路椎弓根螺钉内固定；9例病变累及2个椎体（椎体保留50％以上）者采用单孔腹腔镜技术行一期前路病灶清除、植骨及内固定；2例病变累及2个以上椎体（椎体保留50％以上）者采用改良单孔腹腔镜技术，行一期前路病灶清除、植骨及内固定。术前均用异烟肼、利福平、乙胺丁醇、链霉素四联抗结核化疗2周，术后抗结核治疗9～12个月。结果：均顺利完成手术，手术时间240～365min，平均280min；术中出血量50～400ml，平均112ml。无术中并发症。2例术前神经功能受损患者术后神经功能完全恢复正常，ASIA分级均为E级。1例右侧入路患者术后即出现植物神经功能紊乱，患侧下肢皮肤温度高于对侧．未行特殊处理，术后1周症状消失。1例L4-L5前路内固定患者术后3个月摔倒后出现L5椎体螺钉松动，予内固定拆除，行后路椎弓根螺钉固定。术后2周Cobb角-10°-5°，平均-5．10±2．70，与术前比较有统计学差异（P〈0．01）。随访3～22个月，平均12．1个月。末次随访Cobb角-10°～8°，平均-4．2°±2．1°，与术前比较有统计学差异（P〈0．01），Cobb角丢失2．6°±1．8°。末次随访植骨融合11例，融合时间6～12个月。11例完成抗结核治疗疗程者，末次随访均未见结核复发。结论：腹膜后入路腹腔镜下手术治疗腰椎结核安全．近期效果良好。