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目的:探讨后腹腔镜下切除结核性无功能肾脏的可行性与临床疗效。方法:2005年9月～2007年12月,采用后腹腔镜技术切除结核性无功能肾脏9例,首先解剖出肾脏动、静脉用尼龙夹结扎后切断,而后用Ligasure血管闭合系统于肾周筋膜外分离切除肾脏,保留同侧肾上腺,输尿管尽量向下游离。取同侧下腹小切口,行输尿管全长切除,标本自下腹切口取出。有2例结核性膀胱挛缩患者同时行乙状结肠膀胱扩大术。结果:9例患者腹腔镜手术完全成功,未发生周围脏器及大血管的损伤等严重并发症,无中转开放手术。手术时间120～150 min,平均132 min,失血量70～140 ml,平均110 ml。随访3～15个月,7例患者肾脏功能正常,2例膀胱挛缩行膀胱扩大患者肾功能较术前有好转,尿频尿急等膀胱刺激症状消失,膀胱容量240～300 ml。结论:改良的后腹腔镜下肾脏切除术可以安全的切除结核性无功能肾,对于腔镜经验丰富的操作者可以作为临床治疗结核性无功能肾脏的新选择。
Objective: To investigate the feasibility and clinical effect of retroperitoneoscopic resection of tuberculous non-functional kidney. Methods: From September 2005 to December 2007, 9 cases of tuberculous non-functional kidney were removed by retroperitoneal laparoscopy. First, the renal artery and vein were dissected and ligated with nylon clips, and then ligated with Ligasure’s vascular closure system Membrane separation of the excision of the kidneys, ipsilateral adrenal retention, ureteral as far as possible free. Take the ipsilateral abdominal small incision, the line of ureteral full-length resection specimens removed from the lower abdomen. Two patients with tuberculous bladder contracture at the same time sigmoid colon expansion. Results: Laparoscopic surgery in 9 patients was completely successful. There were no serious complications such as the injury of the surrounding organs and blood vessels, and no open surgery. The operation time was 120-150 minutes with an average of 132 minutes and the blood loss was 70-140 ml with an average of 110 ml. The follow-up of 3 to 15 months, 7 patients with normal kidney function, 2 cases of bladder contracture bladder expansion in patients with renal function improved than before surgery, urinary urgency and other symptoms of bladder irritation disappeared, the bladder capacity of 240 ~ 300 ml. Conclusion: The modified retroperitoneal laparoscopic nephrectomy can safely remove tuberculous nonfunctional kidney, which can be used as a new clinical choice for the clinical treatment of tuberculous nonfunctional kidney by experienced surgeons.