后腹腔镜下肾实质切开取石术的有效性及安全性  

Efficacy and safety of retroperitoneal laparoscopic nephrolithotomy

作　　者：王敏[1] 刘修恒[1] 陈志远[1] WANG Min;LIU Xiu-heng;CHEN Zhi-yuan(Department of Urology,Renmin's Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院泌尿外科,湖北武汉430060

出　　处：《现代泌尿外科杂志》2019年第5期377-380,共4页Journal of Modern Urology

摘　　要：目的探讨后腹腔镜下肾实质切开取石术治疗复杂性肾结石的有效性及安全性。方法回顾性分析2014年1月至2017年12月在武汉大学人民医院泌尿外科收治的16例后腹腔镜下肾实质切开取石术患者的临床资料,对患者的手术时间、术中出血量、引流管留置时间、手术后住院时间、结石清除率以及术后漏尿、感染等参数指标进行分析。结果 16例手术均顺利完成,无中转开放手术;其中5例患者术中留置输尿管内支架管;2例肾实质内结石患者行术中肾动脉阻断,热缺血时间分别为22、28 min,其余患者术中均未行肾动脉阻断;手术时间65～156 min,中位数为124 min;术中出血量20～160 mL,中位数为60 mL,无输血发生;术后肾周引流管留置时间4～7 d,6～8 d拔除导尿管;手术后住院时间为6～9 d;结石清除率为93.75%(15/16);术后无漏尿发生;术后感染2例,出现发热,最高体温39℃,给予加强抗感染2 d后体温恢复正常。结论对于某些特殊类型的肾结石,后腹腔镜下肾实质切开取石术是一种安全、有效且创伤小的治疗选择。Objective To explore the efficacy and safety of retroperitoneal laparoscopic nephrolithotomy for complicated renal calculi.Methods The clinical date of 16 patients with complicated renal calculi who underwent retroperitoneal laparoscopic nephrolithotomy during Jan.2014 and Dec.2017 were retrospectively analyzed.The operation time,blood loss,indwelling time of drainage tube,postoperative length of hospitalization,calculi clearance and complications such as urine leakage and infection were evaluated.Results All operations were successful,and no case converted to open surgery.Double J stent was placed in 5 patients.Block of renal artery was performed in 2 patients,the warm ischemia time being 22 min and 28 min respectively.The median operation time was 124(65-156) min.The median blood loss was 60(20-160) mL.Drainage tube and foley catheter were removed 4-7 days and 5-8 days after operation.The length of hospitalization was 6-9 days.Calculi clearance rate was 93.75%(15/16).No urine leakage occurred after operation.Infection was observed in 2 patients,whose maximum body temperature reached 39 ℃.The temperature returned normal 2 days after enhanced anti-infection therapy.Conclusion Retroperitoneal laparoscopic nephrolithotomy was safe,effective and minimally invasive for some specific types of renal calculi.

关 键 词：肾结石 后腹腔镜 肾实质切开取石术 

分 类 号：R692[医药卫生—泌尿科学]