经腹腹腔镜半肾切除术治疗成人重复肾畸形(附12例报告)

目的:探讨经腹腹腔镜半肾切除术治疗成人重复肾畸形的方法、可行性和临床疗效。方法:回顾我院2010年6月~2014年1月采用经腹腹腔镜行重复肾畸形上半肾切除术治疗12例患者,其中男4例,女8例,年龄18~56岁,平均36岁。左侧9例,右侧3例,12例重复肾畸形患者均为上半肾病变。结果:12例手术均获成功,无中转开放手术。手术时间60~120min,平均90min;术中出血量20~150ml,平均50ml;术后肠道功能恢复时间1~3d,平均2d;术后24~72h进流食,3~4d拔除引流管;术后住院时间7~9d,平均8d;术后随诊6~15个月,平均9个月;术后3、6个月内均行IVU检查,下半肾功能均正常,原发症状消失。结论:经腹腹腔镜半肾切除术治疗成人重复肾畸形具有手术视野开阔、住院时间短、创伤小、恢复快等优点,是治疗成人重复肾畸形安全有效的手术方法。     

RENAL COMPENSATORY HYPERTROPHY IN CHILDREN WITH UNILATERAL RENAL DISEASE

Abstract. Wilton, P., Aperia, A., Broberger, O. and Wikstad, I. (Departments of Pediatrics and Pediatric Radiology, Karolinska Institute, St. Göran's Children's Hospital, Stockholm, Sweden). Renal compensatory hypertrophy in children with unilateral renal disease. Acta Paediatr Scand, 69:83, 1980.—Kidney parenchymal size was estimated on urograms from 22 children with unilateral vesico-ureteral reflux (VUR), 14 children with bilateral VUR and seven children with unilateral heminephrectomy. In the bilateral VUR group, one kidney was roentgenologically normal and the other was growth-retarded. The GFR was estimated in 19 of the children. The age of the children was 3–17 years and all had a history of urinary tract infection. The size of the smaller kidney varied between 33–97% of normal. Children in the unilateral VUR group with a small kidney due to scarring and/or growth retardation showed a varying degree of compensatory hypertrophy in the contra-lateral kidney, which was proportional to the parenchymal reduction. This compensation was inhibited in the bilateral VUR group. There was a positive correlation between the GFR and kidney size     

Retroperitoneoscopic left upper moiety heminephroureterectomy for dribbling incontinence

A 7-year-old girl underwent a prone, retroperitoneoscopic left upper moiety heminephroureterectomy for a non-functioning upper moiety associated with a dilated, ectopic ureter. The dilated ureter was noted prenatally, but postnatal investigations failed to demonstrate the duplex system. The child remained asymptomatic until she represented at 6 years of age, with dribbling of urine. She went on to have an ultrasound scan, dimercaptosuccinic acid and magnetic resonance urogram, which identified a grossly-dilated fluid-filled structure in proximity of the left kidney, but failed to demonstrate the small non-functioning left upper moiety. A computed tomography urogram was more helpful in establishing the diagnosis. Retroperitoneoscopy via three 5-mm ports allowed clear visualisation of both the left duplex ureters, as well as the small non-functioning upper moiety, which had been challenging on the pre-operative imaging. The procedure is described in the accompanying video. The child was discharged home the following day and has been completely well and dry at 6 months' follow-up.     

后腹腔镜下重复肾上位半肾切除术后乳糜漏的临床分析

目的: 探讨后腹腔镜下重复肾上位半肾切除术后乳糜漏的处理及预防措施。方法: 回顾性分析39例在2004年11月至2011年2月间行后腹腔镜下重复肾上位半肾切除术后发生乳糜漏的5例临床资料。其中男4例,女1例,平均42(32~60)岁,对其行保守治疗并观察疗效。结果: 5例术后乳糜漏持续时间5~31 d,且前4例均发生在开展该术式的前2年。乳糜漏均发生于左重复肾上位半肾切除术后;均通过保守治疗成功。结论: 后腹腔镜下重复肾上位半肾切除术后可发生乳糜漏,且以左侧多见;术中手术层面清晰、创面止血确切、并以钛夹或hemolock夹闭损伤的主要淋巴管、在肾蒂上方置泰绫、必要时喷生物蛋白胶等,可有效预防乳糜漏的发生;保守治疗可获满意疗效。     

成人重复肾畸形并肾积水的诊疗分析

目的分析总结成人重复肾畸形并肾积水的诊疗方案。方法回顾性分析40例成人重复肾畸形并肾积水患者的临床资料,其中男性11例,女性29例,年龄18～77岁。并发重度肾积水29例,轻度肾积水11例。结果 29例重度肾积水患者均行肾部分切除术,其中开放手术23例,腹腔镜手术6例;11例轻度肾积水患者中5例行输尿管膀胱再植术,5例行输尿管囊肿电切术,1例行肾盂成形术。40例患者中3例出现术后并发症。结论成人重复肾畸形并重度肾积水者应行肾部分切除术,腹腔镜较之开放手术具有创伤小、出血少、恢复快等优点;轻度肾积水者可通过解除膀胱输尿管返流、输尿管口囊肿、肾盂输尿管连接部梗阻等改善肾功能。     

Follow-up imaging after laparoscopic heminephrectomy in children

BACKGROUND: The radiological findings after laparoscopic heminephrectomy in children are not widely reported. OBJECTIVE: To document the range of imaging appearances following laparoscopic heminephrectomy in children. MATERIALS AND METHODS: We reviewed all imaging and all radiology reports performed on children in our institution who had undergone laparoscopic heminephrectomy over a 6-year period. RESULTS: Between 2001 and 2007, 35 patients (24 girls, 11 boys) had laparoscopic heminephrectomy. The mean age at surgery was 3.5 years. The sites of surgery comprised 12 right upper, 5 right lower, 18 left upper and 3 left lower heminephrectomies. These numbers included three patients who had bilateral procedures. The most consistent postoperative finding was an avascular cyst related to the site of surgery, seen after 23 of 38 procedures. Of these 23 cysts, 13 were simple and 10 were septated and/or contained echogenic debris. CONCLUSION: A cyst related to the site of laparoscopic heminephrectomy is a frequent postoperative occurrence but is not widely recognized for being simply this. Simple, anechoic, and septated appearances are possible. This cyst may be confusing to the radiologist and the clinician if they are not aware of the history of laparoscopic heminephrectomy and the technique that has been used. Whilst the exact aetiology of this cystic lesion is uncertain, all the patients in our series had a heminephrectomy performed with the use of an Endoloop (Ethicon, Somerville, NJ). No patients have required intervention to date.     

后腹腔镜上位半肾切除术治疗重复肾无功能上位肾的体会（附18例报告）

目的：探讨后腹腔镜下行上位半肾切除术治疗重复肾无功能上位肾的技术方法和经验。方法：18例重复肾上位肾无功能的患者,男6例,女12例;右侧8例,左侧10例;年龄6～45岁,平均19岁。均行后腹腔镜上位半肾切除术。观察手术时间、术中出血量、术中术后并发症,随诊下位。肾的功能及手术效果。结果：18例手术均获成功,无中转开放者。手术时间100～150min,平均120min;术中出血20～50ml,平均35ml;术后住院时间6～8天,平均7天。术中术后无明显并发症。随访6个月,效果满意。结论：经后腹腔镜上位半肾切除术治疗重复无功能上位肾安全有效、创伤小、出血少、恢复快、并发症少,可以逐渐替代传统开放手术。     

经腹腹腔镜半肾输尿管切除术治疗成人重复肾畸形(附5例报告)

目的：探讨经腹腹腔镜治疗成人重复肾畸形的手术技巧及效果。 方法：2015-2018年单中心单术者完成成人重复肾畸形患者5例，所有患者均行泌尿系统增强CTU确诊为重复肾。回顾性分析患者的临床资料，包括手术技巧，手术时间，术中出血量，肠道功能恢复时间，住院天数等临床资料。 结果：5例患者均顺利完成手术，手术时间为152±32.7min（110-200min），出血量 106±83ml（50-250ml），术后肠道恢复时间2±1.1天（1-3）天，住院天数7±1.1天（5-8天）。术后随访6-32个月，复查B超、肾功能提示残存肾脏正常。 结论：经腹腹腔镜下重复肾切除技术安全可靠，肾门血管的解剖是保护术后肾脏功能的关键，肾盂粘膜的完整切除是预防尿性囊肿复发的关键。