158例后腹腔镜下结核肾切除术临床分析  

Clinical analysis of retroperitoneal laparoscopic nephron for tuberculous kidneys:A report of 158 cases

作　　者：王强[1] 蔡明[1] 石炳毅[1] 李州利[1] 钱叶勇[1] 柏宏伟[1] 李响[1] 张旭[2] 

机构地区：[1]解放军第309医院全军器官移植研究所泌尿外科,北京100091 [2]解放军总医院泌尿外科,北京100853

出　　处：《解放军医学院学报》2015年第8期794-796,800,共4页Academic Journal of Chinese PLA Medical School

摘　　要：目的总结后腹腔镜下结核肾切除术的方法及经验。方法 2008年1月-2014年8月解放军第309医院共完成后腹腔镜下结核肾切除术158例,男77例,女81例,年龄平均42（21-63）岁;其中5例采用＂切口保护器＂自制单孔腹腔镜通道。术前CT均明确患侧肾明显破坏性改变,术前采用正规抗结核治疗至少15 d。术后常规病理检查。结果 158例术后病理证实肾结核。150例腔镜手术成功,8例（5.1%）术中出血中转改开放手术。血沉平均43（6-80）mm/L;C反应蛋白平均15.5（4-25）mg/L;尿抗酸杆菌阳性率61例（38.5%）,阴性97例（61.4%）;术前病肾小球率过滤平均37.45（9.6-65.3）ml/min。手术时间平均95（55-135）min,术中出血平均110（70-150）ml,单孔腹腔镜手术5例顺利,无中转开放;术中无其他器官损伤;术后1例腹腔结核感染,余术后恢复良好,术中常规留置腹膜后引流管。平均住院13.5（7-20）d。平均随访37（2-72）个月,无结核性窦道形成,无全身播散性结核发生。结论腹腔镜结核肾切除首选经后腹腔入路,手术安全;肾血管寻找、肾周间隙的分离、避免结核病灶破裂和结核性输尿管处理是结核后肾腹腔镜切除的难点。Objective To summarize the method and experience of retroperitoneoscopic nephrectomy for tuberculous kidneys. Methods From January 2008 to August 2014, retroperitoneal laparoscopic were performed in 158 cases with tuberculous kidneys（77 men and 81 women with mean age of 42 years, range 21- 63 years）, including 5 cases with Home-made Single-port Retroperitoneal Laparoscopic Nephrectomy. Severely destructive changes in all cases were found under renal CT, which need antituberculosis therapy for at least 15 days before operation and routine pathological examination after operation. Results Of the 158 cases confirmed by pathology of renal tuberculosis, retroperitoneal laparoscopic nephrectomy were successfully completed in 150 cases while other 8 cases（5.1%） converted to open surgery. The average sedimentation rate was 43 mm/L（6-80 mm/L） and C-reactive protein was 15.5 mm/L（4-25 mg/L）. Urine-Tuberculosis showed positive in 61 cases（38.5%）, negative in 97 cases（61.4%）. The average GFR in diseased kidney was 37.45 ml/min（9.6-65.3 ml/min）. The average operation time was 95 min（55-135 min） and the average intraoperative hemorrhage was 110 ml（70-150 ml）. Home-made Single-port Retroperitoneal Laparoscopic Nephrectomy was successfully completed in 5 cases without conversions to open surgery. All patients recovered after operation with an average hospitalization time of 13.5 d（7-20 d）, only 1 case had abdominal tuberculosis infection, no disseminated tuberculosis infection and formation of tuberculosis sinus tract were found during an average follow-up period of 37 months（2-72 months）. Conclusion The resection of renal tuberculosis is preferred during retroperitoneal laparoscopic surgery, which is safe and effective to retroperitoneoscopic nephrectomy for tuberculous kidneys. There are some difficulties in operation such as separation of renal vascular and perirenal space, avoiding tuberculous lesions rupture and tuberculous ureteral processing.

关 键 词：肾结核 肾切除 腹腔镜 

分 类 号：R699.2[医药卫生—泌尿科学]