超声辅助的腹腔镜下肾实质切开取石术  

Ultrasonic Assisted Laparoscopic nephrolithotomy for management of renal calculi

作　　者：刘小彭[1] 陆敏华[1] 王喻[1] 狄金明[1] 李辽源[1] 高新[1] 

机构地区：[1]中山大学附属第三医院泌尿外科,广州510630

出　　处：《中华腔镜泌尿外科杂志（电子版）》2016年第5期42-44,共3页Chinese Journal of Endourology(Electronic Edition)

基　　金：国家自然科学基金项目(81170564)

摘　　要：目的探讨超声辅助的腹腔镜下肾实质切开取石术的临床应用价值。方法分析2008年1月至2016年1月我院行腹腔镜下肾实质切开取石术8例患者的临床资料，其中男5例，女3例，中位年龄43岁。既往有肾盂输尿管切开取石术史和经皮肾镜碎石取石术（PCNL）史例，PCNL取石失败史2例，多囊肾合并肾结石3例，右肾上盏结石并肾盏重度扩张2例。患者均在气管内麻下行腹腔镜下肾实质切开取石术，同时处理合并疾病。观察术中和术后出血量、结石清除率、术后并发症等指标来评估手术的安全性及治疗效果。结果8例手术均顺利完成，无中转开放手术，术中均未行肾动脉阻断。1例同时行近端输尿管瘢痕粘连松解，3例多囊肾者同时行该侧肾囊肿去顶减压术。1例肾上极巨大囊性扩张者同时行肾实质囊壁部分切除。手术时间100～180min，中位数为116min；术中出血量50～260ml，中位数为80ml；术后平均3d拔除肾周引流管，6~9d拔除尿管，无尿漏发生。术后随访6～36个月，无结石残留及其他并发症发生。结论选择合适病例行腹腔镜肾实质切开取石术具有安全、高效，创伤小，可同时处理肾脏多种合并病变的优势，是PCNL术的重要补充。术中超声使用有助于结石准确定位和减少肾实质损伤。Objectiveo To evaluate the management of renal calculi by laparoscopic nephrolithotomy and report the primary experiences, Methods The clinical data of 8 patients 5 males and 3 females with renal calculi underwent laparoscopic nephrolithotomy were analyzed retrospectively. The mean age was 43 years. One patients had open surgery and percutanous nephrolithotomy （PCNL） previously, two cases were failed in PCNL, three cases were renal calculi with polycystic kidney, one with stone and severe hydronephrosis in upper calyx. All patients were performed transperitoneal or retroperitoneal laparoscopic nephrolithotomy in general anesthesia. The data of operation time, blood loss, calculi clearance and complications were collected for evaluation of the surgery. Results All cases were successfully performed, and none needed open surgery or block of renal artery. One was performed ureteral scar dissecting to relieve the ureteropelvic junction obstruction, and renal cystic unroofed in 3 cases simultaneously. Partial nephrectomy was performed in one case. The operating time was 116 （100-180） min. The blood loss was 80 （50-260） ml. Drainage tube was removed after 3 days. Foley catheter was removed after 6-9 days. No postoperative urinary drainage was observed, and so as residual calculi.Conclusions Laparoscopic nephrolithotomy is a effective, safety and minimal invasive method in selected patients with renal calculi, and especially assisted with ultrasonic probe, which can also deal with several diseases concomitantly.

关 键 词：肾结石 腹腔镜 超声 

分 类 号：R699.2[医药卫生—泌尿科学]