腹膜后通路腹腔镜肾活检术43例临床分析  

Clinical analysis of 43 cases of retroperitoneal laparoscopic renal biopsy

作　　者：邹古明 卓莉[2] 周晓峰[3] 陈海昕[3] 李文歌 Zou Guming;Zhuo Li;Zhou Xiaofeng;Chen Haixin;Li Wenge(Graduate School of Peking Union Medical College, Division of Nephrology, China-Japan Friendship Hospital, Beijing 100730, China;Division of Nephrology, China-Japan Friendship Hospital, Beijing 100029, China;Division of Urology, China-Japan Friendship Hospital, Beijing 100029, China)

机构地区：[1]北京协和医学院研究生院,中日友好医院肾病科,北京100730 [2]中日友好医院肾病科,北京100029 [3]中日友好医院泌尿外科,北京100029

出　　处：《中华医学杂志》2019年第32期2532-2535,共4页National Medical Journal of China

摘　　要：目的了解经皮肾穿刺肾活检术存在安全风险的患者,使用腹膜后腹腔镜术进行肾穿刺活检的优势。方法我们总结了4年(2013年1月至2017年1月)间,中日友好医院进行腹膜后腹腔镜肾活检术的43例不同程度肾功能异常患者,尤其一些超声下肾脏结构较差或观察不清的患者;包括以下特殊情况:需进行肾脏替代治疗(10例)、严重肥胖(5例)、聋哑人(2例)、其余合并难以控制的高血压。以上患者使用3孔法腹腔镜,由腹膜后路径暴露肾脏,使用16-gauge活检针进行活检。穿刺部位实时进行压迫止血,较少情况需要局部喷洒止血凝胶。结果全部病例完成活检,取材满意。平均手术时间59.4min,平均失血量36.5ml。患者常规全身麻醉,均未发生麻醉意外及相关并发症。41例患者术后24h转出手术科室。1例术中发生原因不明弥散性血管内凝血(DIC),通过输注悬浮红细胞及冰冻血浆纠正。1例术后发生尿漏,考虑发生肾门部损伤,后进行修补术。结论腹膜后腹腔镜肾活检术止血好、并发症少、恢复快,是一种安全、可靠、微创的手术活检法,可为经皮肾穿刺活检术的有益补充。Objective Percutaneous renal biopsycurrently is the most important and widely used method of renal biopsy. However, there still are some patients in whom a percutaneous approach may be considered a major risk. In these patients, renal biopsy under direct vision is a reliable alternative. We described our personal technique and experience in a series of Chinese patients who underwent retroperitoneal laparoscopic renal biopsy. Methods We retrospectively reviewed the patients who had performed retroperitoneal laparoscopic renal biopsy over a 4-year period (Jan 2013 to Jan 2017).Forty-three patients with renal dysfunction were involved inour center.Especially some patients showed atrophic kidney and poor visualization on ultrasonography. The patients′ abnormal conditions includeddialysis (10 cases), morbid obesity (5 cases), deaf-mutes (2 cases) and uncontrolled severe hypertension. The kidney was approached via alaparoscopic retroperitoneal route using athree-ports technique. Then biopsies were performed bya 16-gaugebiopsy needle, and hemostasis was achieved by compression.In less cases, a topical spray hemostatic gel was required. Results Biopsy was performed successfully in all cases and adequate renal tissue was acquired.Mean operative time was 59.4 minutes, mean blood loss was 36.5 ml.Under general anesthesia, no anesthetic accidents and related complications were recorded. Forty-onepatients were discharged within 24 h after operation. Onepatient occurred disseminated intravascular coagulationduring operation. Red blood cell transfusion and fresh-frozen plasma infusion were performed. Injury at hilum of kidney was detected in another patient. And extrapyelogenic repair surgery was performed. Conclusions The retroperitoneallaparoscopic renal biopsy is a safe, reliable, minimallyinvasive alternative renal biopsy method with better haemostasis, fewer complications and a rapid recovery. As the helpful supplement of percutaneous renal biopsy, this technique may have to be used more often in the future.

关 键 词：腹腔镜 腹膜后 直视 肾活检 

分 类 号：R692[医药卫生—泌尿科学]