后腹腔镜肾实质切开取石术治疗肾结石  

Analysis of retroperitoneal laparoscopic nephrolithotomy for renal calculi

作　　者：钱庆鹏[1] 于广海[1] 杜浩[1] 

机构地区：[1]大连市中心医院泌尿外科,辽宁大连116033

出　　处：《中国医药科学》2015年第4期182-184,190,共4页China Medicine And Pharmacy

摘　　要：目的探讨后腹腔镜肾实质切开取石术的治疗效果及手术技巧。方法 2012年1月～2014年1月实施后腹腔镜肾实质切开取石术12例。手术采用自制气囊制造后腹腔间隙。切开肾实质,取出结石。将斑马导丝自肾盂放入输尿管,再沿导丝放置D-J管。用可吸收线连续缝合肾实质切口。术后2～4d可下地活动,术后4～6d拔引流管,术后1个月拔除D-J管。结果 12例手术均成功完成,无改开放者,术后无出血、漏尿等并发症。手术时间平均86min（70～125min）,肾蒂阻断时间平均28min（21～35min）,放置D-J管时间平均4.8min（3～8min）,失血量平均90m L（50～150m L）,术后住院时间平均9.6 d（7～14 d）。术后1周复查KUB示无1cm以上结石残留,D-J管位置正常。结论腹腔镜肾实质切开取石术取石彻底,手术时间短,可以作为经皮肾镜碎石术治疗肾结石的补充手段。缩短肾动脉阻断时间,选准肾切口,熟练的缝合技术及双J管置入技术能提高手术成功率及安全性。Objective To evaluate the clinical efficacy of retroperitoneal laparoscopic nephrolithotomy and surgery techniques. Methods 12 cases of retroperitoneal laparoscopic nephrolithotomy were performed during January 2012 to January 2014. Retroperitoneal space was made by self-made balloon. Renal parenchyma was sliced open and the stone was removed. The Zebra Urological Guidewire was placed in ureter through pelvis, and the D-J stents were placed into ureter along the Zebra Urological Guidewire. The incision of renal parenchyma was sutured continuously using absorbable suture. The patients can get up and move around 2-4 days after operation. The drainage tube was removed 4-6 days after operation and the D-J stents was removed until a month after operation. Results All the 12 surgeries were completed successfully without hemorrhagic complications and urine leakage. The mean operation time was 86 mins（70-125mins）, mean renal ischemia time was 28 mins（21-35mins） and that of D-J stents placing was 4.8 mins（3-8min）. The mean blood loss was 90 m L（50-150 m L） and the mean hospital stay was 9.6 days（7-14 days）. Postoperative KUB showed D-J stents in normal position and no stones bigger than 1 cm was left. Conclusion Retroperitoneal laparoscopic nephrolithotomy, with the advantages of less operation time and acceptable rate of stone clearance, can be served as a supplmentary treatment of the percutaneous nephrolithotripsy for renal calculi. Short renal artery clamping time, accurate cut of renal and skillful technique of suture and D-J stents placing can increase the safety of the operation as well as the rate of success.

关 键 词：后腹腔镜 切开取石 肾实质 肾结石 

分 类 号：R699[医药卫生—泌尿科学]