后腹腔镜下切除严重感染粘连性无功能肾(附7例报告)  

Retroperitoneoscopic nephrectomy for infective nonfunctioning kidneywith dense perinephric adhesion (report of 7 cases)

作　　者：周兴[1] 陈志光[1] 邓振农[1] 曾格瓦[1] 苏宇[1] 王东辉[1] 谢文琪[1] 何兆伟[1] 伍信阳[1] 

机构地区：[1]广州医学院第二附属医院泌尿外科,广东广州510260

出　　处：《中国内镜杂志》2005年第8期818-819,827,共3页China Journal of Endoscopy

摘　　要：目的探讨后腹腔镜下切除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7例患者,男5例,女2例;年龄38～59岁,平均44岁.黄色肉芽肿2例,多囊肾并感染1例,肾结核2例,慢性感染2例.左侧4例,右侧3例.7例均行后腹腔镜下肾切除.其中4例行包膜下肾切除,沿肾脏长轴切开增厚的肾包膜,包膜内游离肾实质,紧靠肾门处再次环行切开肾包膜,分离肾血管周围脂肪,使肾蒂组织薄到足以用Ligasure凝固血管,再离断肾蒂,取出标本,留置腹膜后引流管.观察手术时间,术中出血量,术中术后并发症及恢复时间.结果7例手术均获成功.手术1.5～3.0 h(平均2.2 h),术中出血40～120 mL(平均70 mL),术后肠功能恢复时间1、2 d,术中及术后无明显并发症,术后住院5～7d.随访3～12个月,效果满意.结论该术式具有微创、出血少、恢复快和效果好等特点,较好地解决了后腹腔镜下切除严重感染粘连性无功能肾的肾蒂处理难题.[objective] To evaluate the technicaffeasibility and clinical efficacy of retroperitoneoscopic nephrectomy for infective nonfunctioning kidney with dense perinephric adhesion. [Methods] 7 patients（5 males 2 females, mean age 44 years, range 38 to 59 years） were divided into 2cases of yellow granuloma, 1 case of infective polycystic kidney, 2 cases of tuberculous pyonephrosis, and 2 chronic infective pyonephrosis. All of patients, 4 cases having the diseased kidneys on left side and 3 on right side, were performed retroperitoneoscopic nephrectomy. Of the 7 cases, 4 cases were done subcapsular nephrectomy. The blood loss, intraoperative and postoperative complications, intestinal function recovery, and operative efficacy were observed. [Results] M1 the operations were successful, the operative time being 1.5～3.0 h （mean 2.2 h）, the blood loss 40～120 mL （mean 70 mL）, and postoperative intestinal function recovery time 1, 2 d. No complication occurred during and after operation. The hospitally time was 5～7 d after operation. Follow-up of 3～12 months showed satisfactory effects. [Conclusions] The procedure is microtrauma, less blood loss, quicker recover and better effects. Furthermore , it can overcome the difficulty of retroperitoneoscopic dissection and remove of infective non functioning kidney that is tightly adhesive to surrounding tissues.

关 键 词：腹腔镜术 肾切除术 

分 类 号：R692[医药卫生—泌尿科学]