后腹腔镜无功能肾切除术的临床体会(附16例报告)

目的:总结后腹腔镜无功能肾切除术的安全性及手术方法、技巧。方法:回顾分析2013年1月至2016年1月为16例无功能肾患者行后腹腔镜肾切除术的临床资料,观察术前患肾体积、手术时间、手术出血情况、术后并发症情况。结果:16例手术均完成,无一例中转开放手术。患肾直径20~200 mm,平均(102.5±11.3)mm;手术时间105~450 min,平均(208.1±24.1)min;术中出血量40~280 ml,平均(160.0±14.3)ml;术中、术后均未输血;术后发生不全性肠梗阻1例,予以灌肠后恢复;切口拆线后均愈合良好。结论:后腹腔镜无功能肾切除术中对肾动静脉的处理是手术关键。对于积水明显的肾脏可先吸出积水,缩小肾脏体积,沿肾脏边缘分离,这是保证手术安全可靠的方法;后腹腔镜无功能肾切除术后无明显并发症发生,是微创治疗的发展方向,值得进一步推广应用。

Clinical summary of retroperitoneal laparoscopic nephrectomy for nonfunctioning kidney:with a report of 16 cases

Objective:To summarize the safety and surgical skills of retroperitoneal laparoscopic nephrectomy for nonfunctioning kidney.Methods:From Jan.2013 to Jan.2016,16 patients underwent retroperitoneal laparoscopic nephrectomy for nonfunctioning kidney.Clinical data were recorded to observe preoperative renal volume,the operative time,blood loss,postoperative complications and efficacy of treatment.Results:Retroperitoneal laparoscopic nephrectomy was successfully performed in 16 cases and none was converted to open operation.The diameter of diseased kidneys was 20-200 mm with an average of (102.5±11.3) mm.Operative time was 105-450 min with the average of (208.1±24.1) min.Blood loss was 40-280 ml with the average of (160.0±14.3) ml.None case required blood transfusion in operation and after surgery.One case recovered from the incomplete intestinal obstruction after the enema.Surgical incisions of patients healed well after taking out stitches.Conclusions:The key part of retroperitoneal laparoscopic nephrectomy for nonfunctioning kidneys is processing the renal artery and vein.For the hydronephrosis,surgeons should suck out the hydrops firstly to reduce the size of kidneys,and separate along the edge of kidney to complete the operation,that is safe and effective method.No serious complications occur after retroperitoneal laparoscopic nephrectomy for nonfunctioning kidneys,which is the development direction of minimally invasive treatment and is worth popularization and application.