后腹腔镜下肾实质切开取石的可行性  

Feasibility Research of Retroperitoneal Laparoscopic Nephrolithotomy on Renal Calculi

作　　者：唐开发[1,2] 孙发[1,2] 伍国锋[2] 赵伊立 孙超[1] 田源[1] 肖跃海[1] 王鹏飞[1] 

机构地区：[1]贵州医科大学附院泌尿外科,贵州贵阳550004 [2]贵州医科大学医学科学研究所,贵州贵阳550004

出　　处：《贵阳医学院学报》2016年第4期458-460,467,共4页Journal of Guiyang Medical College

基　　金：国家自然科学基金(81300541);贵州省科学技术基金计划项目[黔科合J字(2013)2051号];贵阳医学院附属医院博士基金项目(C-2012-6)

摘　　要：目的：探索后腹腔镜下肾实质切开取石的可行性。方法：选择肾结石病人54例,术前行泌尿系平片（KUB）及泌尿系电子计算机断层扫描（CT）平扫确定结石及部位;采用全身麻醉、健侧卧位手术,采用后腹腔镜四孔法方案于腋中线切口置入腹腔镜,镜下分离肾脏、阻断肾动脉、切开取石、肾脏全层缝合及输尿管留置D-J管,记录手术时间、术中出血量、住院时间、拔引流管及D-J管时间,术后随访治疗效果及残石率。结果：后腹腔镜下完成54例肾结石手术,平均手术时间（86±13.4）min,肾动脉阻断时间（28±4.6）min,失血量（62±7.4）m L;术后（5±1.4）d拔引流管,未发生继发性出血,术后住院时间（8±3.2）d,术后1-3月拔除双＂J＂管;54例患者随访3~12个月,复查KUB及CT,所有患者均无肾盂积水,患肾分泌排泄功能未受影响,残石率3.7%。结论：后腹腔镜肾实质切开取石安全、有效,可作为治疗肾结石的手术方法。Objective： To investigate the feasibility of retroperitoneal laparoscopic nephrolithotomy on renal calculi. Methods： 54 cases with renal calculi were selected this study. Plain abdominal radiography（ KUB） and Computed Tomography（ CT） of urinary system were performed preoperative to locate stones. General anesthesia,lateral position,and the conventional four port laparoscopic scheme were used. By separating the kidney,interruption the renal artery,nephrolithotomy,and a D-J tube indwelling ureter at last; recording operation time,intraoperative blood loss,length of hospitalization,drainage and D-J tube extubation time,postoperative follow-up treatment effect and residual stone rate.Results： Operation was successfully performed in 54 cases. Average operation time was（ 86 ± 13. 4）min; renal artery occlusion time was（ 28 ± 4. 6） min and blood loss was（ 62 ± 7. 4） m L; drainage extubation after operation was（ 5 ± 1. 4） days,no secondary hemorrhage,hospitalization time after operation was（ 8 ± 3. 2） days,and double ＂ J＂ tube was removed 1 - 3 months after operation. 54 patients were followed up visiting for 3 - 12 months,recheck by KUB ＋ CT scan. All of the patients had no hydronephrosis,renal excretory function was not affected and the residual stone rate was 3. 7%. Conclusions： Retroperitoneal laparoscopic renal nephrolithotomy is feasible and could serve as a new choice on renal calculi.

关 键 词：肾结石 肾实质切开取石术 腹腔镜 肾动脉 失血 泌尿系平片 电子计算机断层扫描 

分 类 号：R692.4[医药卫生—泌尿科学]