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目的:探讨后腹腔镜行重度积水无功能肾切除术的手术方法和效果。方法:对36例积水无功能肾患者行后腹腔镜重度积水无功能肾切除术。经典腰部穿刺入路,建立后腹膜气腹,游离出部分无功能肾后先锐性将肾脏破开一小口,吸去大部分肾内积水,然后再游离肾脏,用Hem-o-lok夹夹闭肾蒂血管后,序贯离断肾动静脉,切除患肾,留置腹膜后引流管,其中对于6例积水量>3 000ml的患者,后腹腔镜下更加细致观察肾周间隙,仔细游离积水肾。观察手术时间、术中出血量和术中、术后肠功能恢复和术中、术后并发症及手术效果。结果:36例手术均获得成功,无中转开放,手术时间为60~180min,平均为(92.5±32.8)min。术中出血10~100ml,平均(31.4±5.2)ml。术中、术后均未输血。引流管一般于术后2~3d拔除,对于6例积水量>3 000ml的患者,引流管拔除时间为术后5~7d,无大出血、腹膜破裂、感染、腹腔脏器损伤等并发症。结论:后腹腔镜积水无功能肾切除术是一种微创、安全、有效的术式。对于积水量>3 000ml的重度肾积水患者,术中需仔细观察解剖间隙,术后需密切关注肾功能的变化。
Objective: To investigate the surgical method and effect of retroperitoneal laparoscopic non-functional nephrectomy with severe hydronephrosis. Methods: 36 cases of non-functional renal hydrops were retrospectively analyzed by retrospective laparoscopic non-functional nephrectomy. Classic lumbar puncture approach, the establishment of retroperitoneal pneumoperitoneum, free from some of the non-functional renal sharp first break the kidneys a small mouth, sucked most of the kidney water, and then free the kidneys, with Hem-o-lok folder Closure of renal pedicle vessels, the sequential removal of renal artery and vein, removal of the kidney, indwelling retroperitoneal drainage tube, of which 6 cases of hydrocephalus> 3,000ml patients, retroperitoneoscopic more detailed observation of renal peritoneal space, carefully Free water kidney. Observed the operation time, intraoperative blood loss and intraoperative and postoperative intestinal function recovery and intraoperative and postoperative complications and surgical results. Results: Thirty-six cases were successfully operated without transit and the operation time was 60-180 minutes (mean, 92.5 ± 32.8) min. Intraoperative bleeding 10 ~ 100ml, an average of (31.4 ± 5.2) ml. Intraoperative and postoperative blood transfusion. The drainage tube was generally removed 2 to 3 days after operation. For 6 patients whose water volume was more than 3 000 ml, the drainage tube was removed 5 to 7 days after operation without any complications such as hemorrhage, peritoneal rupture, infection and abdominal organ injury. Conclusion: Retroperitoneal laparoscopic nephrectomy is a minimally invasive, safe and effective surgical procedure. For patients with severe hydronephrosis with a volume of more than 3 000 ml of fluid, careful observation of the anatomic space during the operation should be followed closely with changes in renal function.