后腹腔镜肾实质切开取石术治疗复杂性肾结石的经验总结  

Summary of experience of retroperitoneal laparoscopic nephrolithotomy for complex renal calculi

作　　者：任宇[1] 于广海[1] 杜浩[1] 王艳龙[1] 于松 

机构地区：[1]大连市中心医院泌尿外科,辽宁大连116033

出　　处：《当代医学》2017年第34期39-42,共4页Contemporary Medicine

摘　　要：目的总结后腹腔镜肾实质切开取石术治疗复杂性肾结石的效果及手术技巧。方法 2010年1月~2016年3月本院对复杂肾结石患者实施后腹腔镜肾实质切开取石术23例。男15例,女8例,年龄32~75岁,平均52.6岁。结石长径0.8~5.5 cm,平均2.5 cm。结果 23例手术均成功完成,无中转开放手术者。手术时间40~180 min,平均87 min;9例患者未阻断肾动脉,14例患者肾动脉阻断14~39 min,平均27 min;术中失血量50~450 mL,平均160 mL,无输血病例。术中15例患者放置双J管,放置双J管时间3~8 min,平均4.2 min。术后血红蛋白较术前下降7~22 g/L,平均为10.9 g/L。术后1 d测血清肌酐19例较术前升高,4例较术前下降,平均升高12%。术后住院7~18 d,平均11.2 d。结论后腹腔镜肾实质切开取石术治疗复杂性肾结石安全有效。可吸收线单层缝合肾实质切实可靠。对于合并同侧肾上腺肿瘤、肾囊肿、肾盂旁囊肿等疾病的患者可作为首选。Objective To evaluate the clinical efficacy and surgery techniques of retroperitoneal laparoscopic nephrolithotomy. Methods Retroperitoneal laparoscopic nephrolithotomywas performed in 23 cases(15 male and 8 female) from January 2010 to March 2016. The mean age of patients was 52.6 years(range 32-75 years). The mean long diameter of stone was 2.5 cm(0.8-5.5 cm). Results All the 23 surgeries were completed successfully without transferring open surgery. The mean operation time was 87 min(40-180 min). Renal artery was blocked in 14 cases, the mean renal warm ischemia time was 27 min(14-39 min). The mean intraoperative blood loss was 160 mL(50-450 mL), without blood transfusion. The mean D-J stent placing time was 4.2 min(3-8 min). The mean decreasing of hemoglobin was 10.9 g/L(7-22 g/L). The mean hospital stay was 11.2 days(7-18 days). Conclusion Retroperitoneal laparoscopic nephrolithotomy was safety and efficacy for complex renal calculi. Single-layer suture of renal parenchyma was reliable with absorbable suture. Retroperitoneal laparoscopic nephrolithotomy maybe the first choice for complex renal calculi with adrenal tumor, renal cyst andparapelvic cyst.

关 键 词：腹腔镜 肾实质切开取石术 肾结石 

分 类 号：R699.2[医药卫生—泌尿科学]