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目的:评价后腹腔镜技术进行上半肾输尿管切除术治疗成人重复肾可行性及临床价值。方法:2006年4月~2012年6月,收集分析接受后腹腔镜下上半肾脏输尿管切除术治疗的成人重复肾患者27例临床资料。术中充分游离上半肾后,分别分离结扎上半肾输尿管、动静脉,尽量完整切除上半肾,并用2-0VICRYL线8字缝合肾脏切缘。术后3、6个月复查泌尿系B超,KUB+IVU,随访术后肾周情况及肾功能。结果:27例手术均获得成功,无中转开放手术。平均手术时间146(100~280)min,平均出血120(50~260)ml,术后复查肾功能未见明显改变,无尿漏、尿性囊肿等并发症发生。住院时间6~9d,平均7d。27例患者术后3~6个月均行B超及KUB+IVP检查,下半肾输尿管形态功能正常,无肾周积液。结论:后腹腔镜上半肾输尿管切除术治疗成人重复肾创伤小,是一种安全、有效的方法。
OBJECTIVE: To evaluate the feasibility and clinical value of retroperitoneal laparoscopy in the treatment of repeated renal failure in adults. Methods: From April 2006 to June 2012, clinical data of 27 adult patients with recurrent renal disease treated with laparoscopic upper semirephrectomy were collected and analyzed. Intraoperative full free after the first half of the kidney, respectively, ligation of the ureter on the left kidney, arteriovenous, as complete removal of the upper half of the kidney, and 2-0VICRYL line suture 8-inch kidney. Urine B-ultrasonography, KUB + IVU were reviewed at 3 and 6 months after operation. Peri-renal circumstance and renal function were followed up. Results: All the 27 surgeries were successful. There was no transfer to open surgery. The average operation time was 146 (100-280) min and the average bleeding was 120 (50-260) ml. No significant changes in renal function were found after operation. No complications such as urinary leakage and urinary cyst occurred. Hospitalization time 6 ~ 9d, an average of 7d. Twenty-seven patients underwent B- and KUB + IVP examinations 3 to 6 months after operation. The morphology of the ureter in the lower half of the kidney was normal with no perirenal effusion. Conclusion: Retroperitoneal laparoscopic radical nephroureterectomy is a safe and effective method for the treatment of small renal trauma in adults.