后腹腔镜技术治疗巨大肾积水

目的探讨腹腔镜技术在治疗巨大肾积水中的临床价值。方法该组29例,其中肾盂结石5例,先天性肾盂输尿管交界处狭窄4例,输尿管上段结石11例,输尿管中段结石3例,输尿管上段狭窄2例,中下段狭窄3例,输尿管中段结石并肾盂癌1例。均行后腹腔镜手术,肾切除术18例,肾输尿管全切术1例,离断性肾盂成形术3例,输尿管上段狭窄段切除再吻合1例,肾盂切开取石术1例,输尿管切开取石术4例,输尿管上段切开取石加肾折叠术1例。结果29例手术均成功,手术时间30～245min,术中出血20～600mL。行肾切除者术后2～4d拔除切口引流管,保留肾者术后4～8d无漏尿后拔除引流管,1个月后取出双J管。住院时间7～12d,平均9.2d。随访6～41个月,无严重并发症,保留肾者肾积水均明显减轻,患肾功能均好转。结论后腹腔镜技术治疗巨大肾积水安全,微创,恢复快,可根据不同病情选择手术方式,一般可取代开放手术。

Retroperitoneoscopic operation on giant hydronephrosis

Objective To explore the clinical value of retroperitoneoscopy in the treatment on giant hydronephrosis.Methods The present study comprised 29 cases of giant hydronephrosis,of which,5 cases secondary to pelvis calculus,4 cases to congenital ureteroplvic junction obstruction,11cases to upper ureteral calculus,3 cases to middle ureteral calculus,2 cases to upper ureter stricture,3 cases to middle-lower ureter striture and 1 case to upper ureteral stone combined with pelvic urothelium carcinoma.Retroperitoneoscopy was performed to all 29 patients including nephrectomy in 18 cases,nephroureterectomy in 1 case,dismembered pyeloplasty in 3 cases,ureteral anastomosis in 1 case,pyelolithotomy in 1 case,uroterolithotomy in 4 cases and renal plication combined with uroterolithotomy in 1 case.Results Operations on 29 cases were all successful with operative time ranging from 30 to 245 min(mean,86min.),and blood loss 20 to 600 mL.The retroperitoneal drainage-tubes were removed 2 to 4 days postoperatively for the cases of nephrectomy,and 4 to 8 days after the stop of urine leakage for others.The hospital stay was 7 to 12 day(mean,9.2 days).All 29 patients were available in the follow-up of 6 to 41 months.There was no serious complication was found,the hydronephrosis was remitted and renal function was improved in patients with diseased kidney reserved.Conclusion Retroperitoneoscopy is mini-invasive and effective alternative treatment techniques to open surgery in treatment of giant hydronephrosis,and the method of operation should be selected according to the conditions of patient.