后腹腔镜肾切除治疗结石所致重度积水无功能肾的临床体会（附32例报告）.doc

后腹腔镜肾切除治疗结石所致重度积水无功能肾的临床体会（附32例报告）.doc 后腹腔镜肾切除治疗结石所致重度积水无功能肾的临床体会（附 32 例报 告） 【摘要】 目的 探讨后腹腔镜行结石所致重度积水无功能肾切除术的手术方法和临床体会。 方法 对 32 例结石所致重度积水无功能肾患者行后腹腔镜患肾切除术。 全部实行经腰部途径，建立后腹腔气腹，依据术中详细状况确定夹闭离断肾蒂血管及游离肾脏的先后。 19 例实行游离部分患肾，于患肾戳一小口吸去大部分肾内积水，再全部游离肾脏，用Hem-o-lok 夹夹闭肾蒂血管后，序贯离断肾动静脉，切除患肾。 13 例先用Hem-o-lok 夹夹闭肾蒂血管后，序贯离断肾动静脉后再游离肾脏，再考虑吸尽患肾积水。 常规留置肾窝引流管。 视察手术时间、术中出血量和术中、术后肠功能复原和术中、术后并发症及手术效果。 结果 32 例手术均获得胜利，无一例中转开放，手术时间为 55～180 min，平均为（90.126.9）min；术中出血 20～110 mL，平均（29.94.7）mL。 术中、术后均未输血。 引流管一般于术后 2～3 d 拔除，对于合并脓肾、手术创面大、肾周粘连紧密且渗液多者酌情延长引流管拔除时间。 无大出血、腹膜裂开、感染、腹腔脏器损伤等并发症。 结论 后腹腔镜肾切除治疗结石所致重度积水无功能肾是一种微创、平安、有效、复原快的术式，术中可依据详细状况确定处理肾蒂血管的先后。 【关键词】 后腹腔镜； 无功能肾； 泌尿系结石； 肾切除 The Clinical Experience on Retroperitoneal Laparoscopic Nephrectomy for the Treatment of Severe Hydronephrosis Caused by Calculi （Report of 32 Cases）/ZHU Zun-wei， XIONG Huan-teng， ZENG Tao.//Medical Innovation of China，2015，12（34） 143-146 【Abstract】 Objective To investigate the retroperitoneal laparoscopic operation with severe hydronephrosis caused by calculi s and clinical experience of nephrectomy. 32 cases with calculi caused by severe hydronephrosis underwent retroperitoneal laparoscopic nephrectomyn， who all took the waist approach. After the establishment of gasless celiac， according to the specific circumstances of the operation decision clipped off sequence in the renal vascular pedicle and free of the kidney. In 19 case， the free part of the kidney， and the kidney was a small mouth suction to most of the kidney， and then all the free kidney， with Hem-o-lok clip to close the renal pedicle blood vessels， the left renal artery and vein， to remove the kidney. 13 cases with Hem-o-lok used to clamp the renal pedicle blood vessels， then the renal artery was left off after the renal artery and the renal vein， conventional indwelling renal drainage tube. To observe the amount of bleeding and operation time， intraoperative， postoperative intestinal function recovery and intraoperative， postoperative complications and operation effect. Result All the 32 cases were successful， and no one was converted to open operation， the operation time was 55-180 min， the average was （90.126.9） min. Bleeding changed from 20 to 110 mL， average （29.94.7） mL. All the patients were not blood transfusion after operation. Drainage tube in postoperative was 2-3 d extraction， for combined with renal abscess， surgical wound， perirenal adhesion closely and the seepage liquid bulls at the discretion of the extension of the drainage tube removal. No major bleeding， peritoneal rupture， infection ， abdominal organ injury and other complications. Conclusion Retroperitoneal laparoscopic nephrectomy is a minimally invasive， safe， effective and fast for the treatment of renal calculi. According to the specific circumstances， the treatment of the renal pedicle vessels can be determined according to the specif