腹腔镜切除结核性无功能肾15例报告

目的探讨应用后腹腔镜切除无功能结核肾的临床价值。方法回顾性分析新疆自治区区人民医院15例肾结核行后腹腔镜下结核。肾包膜外切除术的临床资料。结果15例均成功完成单纯肾切除。无中转开放手术，手术时间60～150min，平均90min。术中失血最50~250mL，平均105mL。术后住院时间4～10d，平均7d。术中取出肾脏时有3例肾破裂造成脓液外渗，切口I期愈合。随访1～24个月，平均12个月，肾功能正常。结论后腹腔镜结核肾切除术是一种安全、有效的微创治疗方法。     

后腹腔镜结核肾切除术22例报告

目的　比较后腹腔镜结核肾切除术 (包括后腹腔镜单纯性肾切除术和后腹腔镜包膜下肾切除术)与开放手术方法的应用价值。　方法　①行腹腔镜结核肾切除术 22例 (A组 )。男7例,女15例。年龄 23~53岁,平均年龄 43岁。左肾 14例,右肾 8例。②同期行结核肾开放性肾切除 22例(B组)。男 9例,女 13例。年龄 27~51岁,平均年龄 39岁。左肾 15例,右肾 7例。两组手术均由同一组医师完成。比较两种方法的手术时间、术中失血量、术后平均住院时间、卧床时间。　结果　A组行单纯肾切除者 17例,另 5例因肾周严重粘连改行包膜下肾切除。B组改行包膜下肾切除者7例。A组手术时间为 ( 93. 0±12. 6 )min,术中失血量 ( 78. 3±60. 6 )ml、术后平均住院时间为(3. 3±0. 9)d、卧床时间为(1. 0±0. 2)d,B组上述指标分别为 (92. 6±35. 5)min、(160. 0±120. 0)ml、(9. 1±0. 8)d和(3. 9±0. 4)d;两组手术时间比较差异无统计学意义;但A组术中失血量、术后平均住院时间及卧床时间明显优于B组。　结论　与开放手术相比,后腹腔镜结核肾切除术具有创伤小、出血少、恢复快的优点,后腹腔镜包膜下肾切除术能有效处理粘连极重的无功能结核肾。     

后腹腔镜肾切除术治疗无功能结核肾48例报告

目的探讨后腹腔镜肾切除术治疗无功能结核肾的安全性和有效性。方法回顾性分析2013年6月～2019年6月后腹腔镜无功能结核肾切除术48例资料。术前均明确诊断为无功能性肾结核,对侧肾功能正常。肾脏游离层面前期20例沿肾包膜外游离,后期28例沿肾周脂肪囊外游离。仔细游离肾蒂,解剖出肾动静脉后切断。输尿管均游离至髂血管附近切断。结果 48例手术均顺利完成,无中转开放手术。腹膜破裂5例,肾包膜破裂3例(其中2例脓液外流)。手术时间150～260 min,平均170 min,出血量50～300 ml,平均150 ml。术后住院时间8～14 d,平均9.5 d。切口感染2例。术后抗结核治疗并随访9～18个月,平均12个月,无不适症状,肾功能正常。结论后腹腔镜肾切除术治疗无功能肾结核安全、可靠、有效。     

后腹腔镜下包膜内切除严重感染粘连性无功能肾的术式探讨

目的探讨后腹腔镜包膜内切除严重感染粘连性无功能肾的技术方法和临床应用价值。方法9例患者，男5例，女4例。年龄38～61岁，平均46岁。肾结核5例，肾非特异性感染4例。左侧5例，右侧4例。9例均行后腹腔镜包膜内肾切除，沿肾脏长轴切开增厚的肾包膜，包膜内游离肾实质，紧靠肾门处再次环行切开肾包膜，分离肾血管周围脂肪，使肾蒂组织薄到足以用血管闭合系统（LigaSure）凝固肾动静脉。离断肾蒂，取出标本，留置腹膜后引流管。记录手术时间，术中出血量，术中术后并发症及恢复时间。结果9例手术均获成功。手术时间1．5—3．0h，平均2．2h；术中出血量40～120ml，平均70ml；术后胃肠功能恢复时间1—2d；术中及术后无明显并发症；术后住院6～8d。随访1～10个月，效果满意。结论该术式具有微创、出血少、恢复快、效果好等特点，较好地解决了严重感染粘连性无功能肾的肾蒂处理难题。     

后腹腔镜结核性无功能肾切除22例临床分析

目的:探讨应用后腹腔镜在结核性无功能性肾切除的临床价值。方法:回顾分析2008年9月~2013年3月对22例结核性无功能肾患者行后腹腔镜肾切除术的临床资料。结果:22例手术均顺利完成,无中转开放手术。手术时间70~140min,平均90min。术中失血量40~350ml,平均100ml。术后住院4~8d,平均6d。术中4例肾包膜撕裂少许干酪样脓液外渗,6例腹膜损伤。所有患者切口均一期愈合。术中术后无明显并发症。术后随访6~36个月,平均12个月,对侧肾功能正常。结论:后腹腔镜结核肾切除术是一种安全、有效的微创治疗方法,因其创伤小、出血少、恢复快,值得进一步临床推广。     

后腹腔镜单纯性肾切除术6例报告

目的探讨后腹腔镜单纯性肾切除术的临床价值. 方法采用后腹腔镜行单纯性肾切除术6例,其中输尿管结石致肾积水无功能肾5例,肾结核1例.经后腹腔操作,分离出输尿管显露肾蒂, 肾动脉、肾静脉钛夹夹闭后切断,单纯采用钛夹处理肾蒂切除肾脏. 结果手术均获成功,无手术并发症发生.手术时间130～220 min,平均150 min;术中出血量80～150 ml,平均120 ml;术后住院5～7 d.5例输尿管结石随访3个月,肾功能正常;1例肾输尿管结核抗结核治疗6个月,随访无复发,血肌酐120 μmol/L稍高于正常. 结论腹腔镜单纯性肾切除术创伤小、恢复快,可成为单纯性肾切除的金标准术式.     

后腹腔镜下结核性无功能肾切除术

目的探讨后腹腔镜切除结核性无功能肾的有效性及安全性。方法2005年8月～2009年2月,对21例肾结核行后腹腔镜下肾切除术。用等离子钳游离肾脏与输尿管,Hem-o-lok阻断肾蒂,18例肾放入肾袋后取出,3例患侧下腹部取斜行切口处理输尿管及取肾。手术前后均行正规抗结核治疗。结果21例均成功完成肾切除,无一例中转开放手术,手术时间75～210min,平均105min。术中失血量40～220ml,平均100.5ml。术后住院时间4～9d,平均6.5d。术中3例肾包膜撕破造成少量干酪样脓液外渗,腹膜损伤5例。切口一期愈合20例,1例术后局部窦道形成,二次手术,输尿管残端切除术后治愈。随访3～24个月,平均12个月,6例因膀胱挛缩,术后3个月行结肠扩大膀胱术。结论后腹腔镜切除结核性无功能肾创伤小、恢复快,对于结核性无功能肾是一种安全、有效的手术方法。     

后腹腔镜保留肾脏手术治疗肾肿瘤

目的探讨后腹腔镜保留肾脏手术治疗肾肿瘤的手术方法和临床效果。方法采用后腹腔镜技术使用超声刀对13例肾良性肿瘤和5例肾恶性肿瘤患者分别行肿瘤剜除术和肾楔形切除术。男7例，女11例。平均年龄51岁。肿瘤直径1．5～4．0cm，平均2．8cm。观察手术时间、术中出血量、术后住院天数和术中术后并发症及手术效果。结果18例手术均获得成功。平均手术时间87min，平均出血量55ml，平均术后住院时间5．8d。围手术期无并发症。病理检查5例恶性肿瘤切缘阴性，平均随访10个月无局部复发。结论后腹腔镜肾部分切除术安全可行，切除肿瘤精确彻底，创伤小，恢复快，值得临床有选择地推广使用。     

后腹腔镜结核性无功能肾切除术

目的:比较后腹腔镜结核肾切除术与开放手术的方法和疗效.方法:对7例无功能性结核肾行后腹腔镜结核肾切除术,同期11例行开放肾切除术,比较两组的手术时间、术中出血量、术后住院天数、并发症及手术疗效.结果:2组患者均顺利完成手术,平均手术时间分别为122 min(60～270 min)和96 rain(60～150 min),平均术中出血量分别为81 m1(20～400 m1)和255 ml(50～1 000 ml),平均术后住院天数分别为7天和9天,术中术后无明显并发症.结论:后腹腔镜结核肾切除术是一种安全、有效的微创治疗方法.后腹腔镜肾切除为肾结核的手术治疗提供了一条新的途径.     

腹腔镜辅助子宫肌瘤切除术28例临床分析

目的：评价腹腔镜辅助子宫肌瘤切除术的效果。方法：回顾分析28例腹腔镜辅助子宫肌瘤切除术的临床资料。结果：28例手术均获成功，其中肌壁间肌瘤18例，浆膜下肌瘤（无蒂）6例，阔韧带肌瘤3例，峡部肌瘤1例，肌瘤直径0．5—15era，平均6．5cm。手术时间40—150min，平均60min，术中出血30—200ml，平均60ml，术后住院4—8d，平均5d。随访2—36个月，平均9个月，无复发。6例不孕症患者中2例妊娠。结论：腹腔镜辅助子宫肌瘤切除术兼具传统与微创手术的优点，安全可行。     

后腹腔镜结核性无功能肾切除术的临床体会

目的:探讨后腹腔镜肾切除术治疗无功能性肾结核的临床应用价值。方法:2008年9月至2011年9月为32例肾结核患者行后腹腔镜结核性肾切除术。术中使用超声刀游离肾脏与输尿管,阻断肾蒂,切除的肾脏放入肾袋取出。手术前、后均行正规抗结核治疗。结果:32例手术均获成功,无一例中转开放手术。手术时间90～200 min,平均130 min;术中出血量30～140 ml,平均60 ml;术后住院5～9 d,平均7.1 d;术中、术后无明显并发症发生。结论:后腹腔镜肾切除术治疗结核性无功能肾安全、有效、微创,为肾结核的手术治疗提供了新途径。术前需积极进行抗痨治疗,术中科学、合理、仔细操作。     

后腹腔镜结核性无功能肾切除术23例报告

目的:探讨后腹腔镜结核性无功能肾切除术的临床应用价值。方法:回顾分析2012年7月至2016年3月为23例结核性无功能肾患者行后腹腔镜肾切除术的临床资料,其中男9例,女14例,平均(39±3)岁;患者均为无功能肾,右侧11例,左侧12例。经过2周抗结核治疗后患者均行后腹腔镜肾切除术。结果:23例患者均成功完成肾切除术,无一例中转开放手术。手术时间73～196 min,平均(125±12)min;术中失血量79～420 ml,平均(198±17)ml;术后住院5～10 d,平均(7.5±0.7)d。术中均未发生脓肾破裂、腹膜损伤,其中1例术后发生输尿管残端积脓感染,二期行输尿管切除术。随访1～36个月,平均(17.0±1.3)个月,肾功能正常。结论:后腹腔镜结核性无功能肾切除术具有良好的安全性、可行性,值得在具备条件的医院推广应用。但因腹膜外空间较小,且结核肾周围粘连较重,对术者技术水平要求较高,需熟练掌握解剖,严格把握手术适应证,术中仔细辨认组织层次。     

后腹腔镜脂肪囊外结核肾切除46例报告

目的：探讨后腹腔镜脂肪囊外切除结核肾的应用价值。方法：回顾性分析2008年1月～2011年6月46例肾结核患者行后腹腔镜下结核肾脂肪囊外切除术的临床资料：男19例,女27例,中位年龄34（20～64）岁。打开侧锥筋膜和Gerota筋膜后,背侧紧贴腰大肌在脂肪囊外游离,腹侧在脂肪囊和Gerota筋膜之间游离。用Hem—O—lok（41例）或Endocutter（3例）处理。肾蒂,把肾放入肾袋后取出。结果：除早期2例因肾门处渗血视野不清中转开放外,44例均成功完成脂肪囊外肾切除。手术时间为118（80～186）min,术中失血量45．4（10～350）ml,术后住院时间为6．5（5～8）天。无腹膜损伤和脓肾破裂,围手术期无并发症,切口均一期愈合。46例随访1～43个月,平均19个月,对侧肾功能正常。结论：后腹腔镜脂肪囊外方法行结核肾切除术便于游离、创伤小、出血少、恢复快,对于结核肾是一种比较安全、可靠的手术方法。     

Outcome of retroperitoneoscopic nephrectomy for benign nonfunctioning kidney: a single-center experience

OBJECTIVE: To analyze the feasibility and outcome of retroperitoneoscopic nephrectomy for benign nonfunctioning kidneys and compare it with open simple nephrectomy. MATERIALS AND METHODS: From January 1998 to December 2006, 505 retroperitoneoscopic nephrectomies were performed. In the same time period, 112 open nephrectomies were also performed. In the retroperitoneoscopic group, the mean age was 39 years (range 15-74 years); 204 (40.4%) were men and 301 (59.6%) were women. Forty in this group had a history of surgery. Thirty-six patients had a pyonephrotic kidney; 33 of these patients had undergone percutaneous nephrostomy preoperatively. The cause of the nonfunctioning kidney was ureteropelvic junction obstruction in 198 patients, calculus disease in 193 patients, genitourinary tuberculosis in 48 patients, renal dysplasia in 19 patients, anomalous kidney in 20 patients, and renovascular hypertension in 16 patients. In 11 patients, there were other causes for the nonfunctioning kidney. RESULTS: Retroperitoneoscopic nephrectomy was performed in 476 (94.2%) patients. Conversion to open nephrectomy was necessary in 25 patients. The mean operative time was 85 minutes (range 45-240 min) in the retroperitoneoscopic group and 70 minutes (range 35-120 min) in the open group. The mean blood loss was 110 mL (range 30-600 mL) in the retroperitoneoscopic group and 170 mL (range 70-500 mL) in the open group. Four (0.8%) patients in the retroperitoneoscopic group needed a blood transfusion, whereas 5 (4.5%) patients in the open group had a blood transfusion. The hospital stay in the retroperitoneoscopic group was 3 days (range 1-7 d) and was 5 days (range 3-12 d) in the open group. CONCLUSIONS: Retroperitoneoscopic nephrectomy, although technically challenging, is becoming a gold standard for patients with nonfunctioning kidneys caused by benign conditions.     

Comparison of retroperitoneoscopic nephrectomy with open surgery for tuberculous nonfunctioning kidneys

PURPOSE: We describe, define and evaluate the role of retroperitoneoscopic nephrectomy for tuberculous nonfunctioning kidneys, and compare the results with those of open nephrectomy in similar cases in a nonrandomized study. MATERIALS AND METHODS: Beginning in July 1994, 9 patients underwent retroperitoneoscopic nephrectomy for tuberculous nonfunctioning kidneys at our center. Data obtained from the records of these patients were compared with those of 9 who underwent open nephrectomy for a similar indication during the same period. Retroperitoneoscopic nephrectomy was initially performed by kidney dissection followed by ligation of the hilar vessels. The technique was subsequently modified and the vessels controlled before dissecting the kidney. Various parameters were compared and statistical analysis was done. RESULTS: The 2 groups were similar in regard to patient age, gender and side of disease. Retroperitoneoscopic nephrectomy was successful in 7 of the 9 patients. Although 2 of our initial patients required conversion to open surgery, the remaining 7 successfully underwent retroperitoneoscopic nephrectomy after modifying the technique. Mean operative time was slightly greater in the retroperitoneoscopy than in the open surgery group (103.3 versus 92.2 minutes). Mean blood loss was less in the retroperitoneoscopy group (101.4 versus 123.3 ml.), mean hospital stay plus or minus standard deviation was significantly shorter (3.2 +/- 0.83 versus 8.88 +/- 3.37 days) and mean time to return to work was significantly less (3 versus 7 weeks). Mean analgesic requirement for opioids and diclofenac sodium was also lower in the retroperitoneoscopic nephrectomy group (0 versus 1.44 +/- 0.72 and 3.8 +/- 1.3 versus 4.3 +/- 1.2 doses, respectively). Minor complications developed in only 2 retroperitoneoscopy cases. CONCLUSIONS: Tuberculosis has been considered a contraindication to retroperitoneoscopic nephrectomy due to a high conversion rate. However, we believe that our modified technique of retroperitoneoscopic nephrectomy is a viable option for managing tuberculous nonfunctioning kidneys. The conversion rate is lower than previously reported. Comparing our results with those of open nephrectomy shows that retroperitoneoscopic nephrectomy is beneficial in all respects except for slightly longer operative time. Because of the benefits of minimally invasive surgery, this approach should be considered in such cases.     

腹膜后腹腔镜结核性无功能肾切除术35例报告

目的:探讨腹膜后腹腔镜切除结核性无功能肾的应用价值。方法:回顾分析2008年7月至2010年12月为35例肾结核患者施行腹膜后腹腔镜结核肾切除术的临床资料。结果:本组35例患者均顺利完成腹膜后腹腔镜肾切除术,无一例中转开放手术。手术时间80~190min,平均(115.0±32.7)min;术中失血量30~200ml,平均(105.1±54.5)ml,均未输血。术后均无并发症发生,切口一期愈合。术后住院3~8d,平均(6.3±1.4)d。术后随访2~30个月,平均(14.9±7.2)个月,对侧肾功能正常。结论:腹膜后腹腔镜结核性无功能肾切除术安全有效,具有出血少、患者创伤小、住院时间短等优点,是结核性无功能肾切除的最佳术式,值得进一步临床推广。     

后腹腔镜辅助小切口切除严重感染粘连性功能肾（附12例报告）

目的：探讨后腹腔镜辅助小切口切除严重感染粘连性无功能肾的临床价值.方法：回顾性分析2006年1月～2008年11月采用后腹腔镜辅助,小切口切除严重感染粘连性无功能肾患者12例.男5例,女7例,年龄34～48岁,平均44岁.多囊肾并感染1例,肾结核6例.慢性感染5例,其中肾积脓行肾穿刺造瘘或输尿管插管引流术后3例.左侧5例,右侧7例.12例均行后腹腔镜辅助小切口行包膜下肾切除术.观察手术时间、术中出血量、术后肠功能恢复和术中、术后并发症及手术效果.结果：12例手术均获成功.手术时间70～130min,平均96 min 出血量50～180 ml,平均110 ml 术后肠道功能恢复时间24～48 h 术后住院时间7～11天,平均8天 术中及术后无手术并发症.术后随访3～12个月.效果满意.结论：后腹腔镜辅助小切口包膜下肾切除术是治疗严重感染粘连性无功能肾的较实用、安全、有效、微创的手术,值得临床选择应用.     

The role of retroperitoneoscopy in the management of renal and adrenal pathology.

OBJECTIVES: To describe the technique, findings and results of retroperitoneoscopic ablation of recalcitrant renal, giant adrenal and complex peripelvic cysts, and nephrectomy for nonfunctioning congenital anomalous kidneys. PATIENTS AND METHODS: Nine patients (six men and three women, mean age 56 years, range 44-68, five with renal, two with adrenal and two with peripelvic cysts, diameter 6-14 cm) were treated by retroperitoneoscopic cyst ablation using three 10-mm ports. Six further patients (two male and four female, mean age 24 years, range 13-38) underwent retroperitoneoscopic nephrectomy using three or four ports for anomalous nonfunctioning kidneys; three patients had a pelvic kidney, two a horseshoe kidney and one an iliac kidney. Isthmusectomy was also performed in the patients with horseshoe kidneys. RESULTS: Retroperitoneoscopic cyst ablation was successful in all nine patients; the mean (range) operative duration was 69 (50-85) min in patients with simple renal and adrenal cysts, and 185 (160-210) min in patients with peripelvic cysts. The mean (range) blood loss was 130 (50-200) mL and hospital stay 2.33 (2-4) days. At the last follow-up, 15-39 months after the procedure, all patients were asymptomatic and satisfied with the outcome, with no recurrence of cysts. Retroperitoneoscopic nephrectomy with isthmusectomy (when applicable) was successful in the six patients with anomalous kidneys, with a mean (range) operative duration of 105 (85-120) min; the mean (range) blood loss was 116 (75-150) mL and the analgesic requirement 208 (150-250) mg of diclofenac sodium. The hospital stay was 2-3 days and the delay before return to preoperative activity 7-14 days. CONCLUSIONS: Retroperitoneoscopic cyst ablation is a safe and effective method to treat symptomatic cysts of the upper urinary tract which are refractory to other forms of management. Dissection is difficult in patients with peripelvic cysts. Retroperitoneoscopic nephrectomy for anomalous kidneys is a challenging procedure because of the abnormal location, anomalous vessels and presence of an isthmus. With advances in laparoscopy and increasing experience, open surgery for such conditions is likely to become obsolete.