预防后腹腔镜治疗复杂肾囊性疾病术后尿漏的经验总结——附59例报告  

The experience of avoiding the complication of urinary leakage after retroperitoneal laparoscopy procedure for complicated renal cystic disease——a report of 59 cases

作　　者：陈羽[1] 黄小萍[1] 丘少鹏[1] 

机构地区：[1]中山大学附属第一医院泌尿外科,510080

出　　处：《新医学》2009年第10期654-655,660,共3页Journal of New Medicine

基　　金：广东省医学科学基金资助项目(A2006179)

摘　　要：目的:总结预防后腹腔镜治疗复杂肾囊性疾病术后尿漏的经验。方法:1997年4月-2008年12月术前诊断为肾囊性疾病的患者59例,予行后腹腔镜肾囊肿去顶术(术后诊断为单纯肾囊肿36例、多囊肾21例、肾盏憩室2例、肾盂旁囊肿2例)。其中2001年后收治的43例均于术前常规予输尿管逆行插管留置导管,术中经输尿管导管注射染料(亚甲蓝),观察由亚甲蓝显示的集合系统情况,如发现集合系统损伤,即进行相应处理。结果:59例患者均顺利完成手术。术后发生尿漏并发症共5例。应用输尿管逆行插管注射染料技术前、后尿漏发生率分别是25%(4/16)、2%(1/43),比较差异有统计学意义(P<0.05)。术后59例随访3个月～8年,复查B超和(或)CT均未见复发。结论:术中输尿管逆行插管注射亚甲蓝可降低后腹腔镜治疗复杂肾囊性疾病术发生尿漏并发症的风险,是预防尿漏的重要措施。Objective： To summarize the experience of avoiding the eomplication of urinary leakage after retroperitoneal laparoscopy procedure for complicated renal cystic disease. Methods： Unroofing of cyst of kidney by retroperitoneal laparoscopy was performed in 59 patients diagnosed as renal cyst（ including 36 cases with simple cyst, 21 cases with polycystic kidney disease, 2 cases with pyelogenic cyst and 2 cases with parapelvic cyst）from April 1997 to December 2008. In the complicated renal cyst eases after 2001, retrograde catheterization of ureters were routinely conducted before the procedure, and methylene blue dye were injected into ureter during the proce- dure. Collection system impairment was immediately repaired when identified. Results： All 59 cases were successfully completed the operation. There were 5 cases of post-procedure urinary leakage. The rates of urinary leakage preand post-injection of methylene blue dye were 25% （4/16）and 2% （1/43）, respectively significant difference. No recurrence was observed during follow-up from 3 months to 8 years. Conclusion： Retrograde catheterization of ureter with dye injection decreases the risk of urinary leakage complication of retroperitoneal laparoscopy for complicated renal cystic disease, and it is an important measure to avoid urinary leakage.

关 键 词：肾囊肿 腹腔镜 并发症 亚甲蓝 多囊肾 肾盂旁囊肿 

分 类 号：R699[医药卫生—泌尿科学]