后腹腔镜结核肾切除术12例报告

目的了解后腹腔镜结核肾切除的应用价值。方法选取2005年1月~2008年12月进行的12例后腹腔镜结核肾切除术及12例开放性结核肾切除术病例,比较两组的手术时间、术中出血量、术后住院天数及术后切口愈合情况。结果 12例后腹腔镜手术有11例顺利完成,1例转为开放手术。两组的平均手术时间无明显差异（后腹腔镜组平均134 min,开放手术组平均120 min,P〉0.05）,但后腹腔镜组的术中平均出血量、术后住院天数明显小于开放手术组,切口愈合情况较开放手术组更好（出血量后腹腔镜组平均110 mL,开放手术组平均130 mL,P〈0.05;术后住院天数后腹腔镜组平均8 d,开放手术组平均10.8 d,P〈0.05）。结论后腹腔镜结核肾切除术适应证与开放性结核肾切除术类似,同时具有出血少、术后住院时间短、切口愈合更好的优点,值得广泛应用。     

LigaSure血管闭合系统在腹腔镜肾切除手术中的应用

目的 探讨LigaSure血管闭合系统在腹腔镜肾切除术中的应用价值. 方法 2004年5月至2006年12月应用LigaSure完成41例腹腔镜下单纯肾切除术、腹腔镜根治性肾切除术及腹腔镜肾输尿管全长切除术.观察手术时间、术中出血量、是否中转开放、术后引流时间、术后引流量、术后住院时间以及并发症等情况. 结果 41例手术均获成功,无中转开放手术及严重并发症.手术时间35～240 min,平均146 min;术中出血量30～450 ml,平均163 ml;术后引流1～6 d,平均3 d;术后总引流量45～435 ml,平均229 ml;术后住院时间6～21 d,平均10 d. 结论 腹腔镜下手术中LigaSure能安全高效地闭合血管及组织束,显著减少手术时间和术中出血,缩短术后住院天数,是一种有效的血管控制系统,在腹腔镜下肾切除术中具有良好的应用前景.     

后腹腔镜肾输尿管部分切除术治疗重复肾输尿管畸形

目的探讨后腹腔镜下治疗重复肾输尿管畸形的方法和疗效。方法回顾性分析18例重复肾输尿管患者经后腹腔镜切除术后的的临床资料,统计手术时间、术中出血量、术后住院时间、术中和术后并发症及随访情况。结果 18例手术均获成功,其中1例中转开放。17例手术时间85～190min,平均116min。术中出血量35～195ml,平均65ml。术后住院6～18d,平均7d。术中、术后未见明显并发症,术后随访肾功能和超声未见明显异常。结论后腹腔镜下治疗重复肾输尿管畸形安全易行,疗效良好。     

Hem-o-lok结扎夹在腹腔镜肾切除肾蒂处理中的应用

目的:探讨腹腔镜肾切除术中用Hem-o-lok结扎夹处理肾蒂的方法、优势及其应用价值.方法:2004年1月～2006年9月行腹腔镜肾切除术56例,其中38例术中应用Hem-o-lok夹处理肾蒂血管,包括腹腔镜单纯肾切除9例,腹腔镜.肾癌根治术18例,腹腔镜肾输尿管全长切除术11例.观察手术时间、术中出血量、是否中转开放、术后胃肠功能恢复时间、术后住院时间以及术后并发症等情况.结果:应用Hem-o-lok夹处理肾蒂的38例腹腔镜肾切除手术均获成功,无一例转为开放手术,术中术后无肾血管出血及其他严重并发症.手术时间35～270 min,平均165 min;术中出血量50～600 ml,平均187 ml;术后胃肠道功能恢复时间18～72 h,平均32h;术后住院时间7～16天,平均11天.结论:在腹腔镜.肾切除术中,Hem-o-lok结扎夹可以安全快速可靠的处理肾蒂血管,是一种新型有效的血管控制系统,具有广阔的应用前景.     

后腹腔镜肾切除术(附23例报告)

目的探讨后腹腔镜肾切除术的临床应用价值.方法采用后腹腔镜技术实施肾切除23例,其中单纯肾切除12例,根治性肾切除6例,肾输尿管全切并膀胱袖套状切除5例.结果手术全部成功,无中转开放手术.手术时间35～240 min,平均135 min.术中出血量30～800 ml,平均90 ml.术后2～4 d下床活动.术后住院7～15 d,平均8.6 d.结论后腹腔镜肾切除术具有创伤小、恢复快、并发症少等优点,临床疗效可靠,具有良好的应用前景.     

后腹腔镜下肾部分切除术的临床分析

目的 评价腹膜后腹腔镜肾部分切除术的可行性及临床价值.方法 39例肾占位患者行后腹腔镜肾部分切除术,肿瘤直径2.5 ～4.6cm,平均3.8cm.手术时,所有的患者都行肾蒂血管阻断.评价手术时间、肾蒂阻断时间、出血量、并发症及肿瘤复发情况.结果 38例手术顺利完成,1例中转开放,阻断肾蒂时间为21～ 36min,平均26min,手术时间70～145min,平均102min,术中出血60 ～ 900ml,平均105 ml.术后病理为32例肾癌,7例错构瘤.术后并发尿漏1例,放置双J管治愈.术后住院7 ～15d,平均l0d,随访3 ～36个月无肿瘤复发.结论 腹膜后腹腔镜肾部分切除术患者创伤小,术后康复快,值得临床推广.有可能代替开放手术,可能成为治疗肾脏局限性占位病变的首选治疗方法.     

3D腹腔镜与2D腹腔镜根治性肾切除术的疗效比较

目的:比较3D腹腔镜和2D腹腔镜根治性肾切除术疗效,评价3D腹腔镜根治性肾切除术的实用性、安全性及疗效。方法:2014年1~10月手术治疗肾脏恶性肿瘤50例,其中采用3D腹腔镜根治性肾切除术治疗30例(3D组),采用2D腹腔镜根治性肾切除术治疗20例(2D组)。所有手术均有同一人完成。对两种手术时间、术中出血量、术后胃肠道恢复时间(以排气为准)、术后住院天数、并发症发生率、手术总费用等进行比较并进行统计学分析。结果:3D组和2D组平均手术时间分别为89.03min和109.80min,前者手术时间明显短于后者(P0.01);术中出血量分别为100.60ml和143.00ml,前者明显少于后者(P0.01);术中及术后均未出现任何并发症,二者手术费用无明显差别。结论:3D腹腔镜根治性肾切除术安全有效,与2D腹腔镜术相比,3D腹腔镜在手术时间、术中出血量方面优于传统2D腹腔镜,且二者手术费用无明显差别。     

腹膜后入路3D腹腔镜肾脏手术探讨:附视频

目的探讨腹膜后入路3D腹腔镜进行常见肾脏手术的技巧和安全性。方法 2012年11月至2014年3月,中山大学孙逸仙纪念医院泌尿外科对103例常见肾脏疾病患者行了腹膜后入路3D腹腔镜手术,其中肾癌根治术28例,肾部分切除术28例,单纯肾切除术24例,肾囊肿去顶减压术12例,肾盂输尿管离断成形术11例。观察指标主要包括手术时间、出血量、术后住院时间、并发症等。结果 103例患者均在3D腹腔镜下顺利完成手术,无中转开放手术或者常规腹腔镜手术病例,所有病例无重大并发症发生。3D腹腔镜肾癌根治术中位手术时间70 min,平均出血量60 ml,术后住院时间平均5 d。3D腹腔镜肾部分切除术中位手术时间90 min,平均热缺血时间22 min,平均出血量90 ml,术后住院时间平均6 d,无切缘阳性病例。3D腹腔镜单纯肾切除术中位手术时间60 min,平均出血量50 ml,术后住院时间平均5 d。3D腹腔镜肾囊肿去顶减压术中位手术时间40 min,平均出血量30 ml,术后住院时间平均3 d。3D腹腔镜肾盂输尿管离断成形术中位手术时间80 min,平均出血量50 ml,术后住院时间平均6 d。结论腹膜后入路3D腹腔镜进行常见肾脏手术安全可行,尤其是镜下缝合精准快速,值得在已经熟练掌握腹腔镜技术的医院推广应用。     

腹腔镜肾部分切除术(附15例报告)

目的 评价腹腔镜肾部分切除术治疗肾脏肿痛的临床效果。方法 2004年1月至2005年4月采用腹腔镜经腹腔或后腹腔途径对15例肾肿瘤患者行肾部分切除术。男11例，女4例。平均年龄52岁（29～70岁）。局限性肾透明细胞癌12例，平均肿瘤直径3．0cm（2．0～4，0cm）；肾血管平滑肌脂肪瘤3例，平均肿瘤直径4．5cm（3．5～6．0cm）。观察手术时间、术中出血量、住院天数、并发症及手术效果。结果 15例手术顺利。平均手术时间120min（80～150min），术中平均出血量150ml（100～220ml），无输血、中转开放手术病例。术后无并发症，平均住院时间8d（7～9d）。随访2～16个月肿瘤无复发。结论 腹腔镜肾部分切除术安全有效，但需长期随访以确定其远期疗效。     

486例肾上腺疾病外科治疗的回顾性分析

目的 总结腹腔镜手术与开放手术在肾上腺疾病外科治疗中的临床经验.方法 回顾性分析486例肾上腺疾病患者的临床资料,其中478例行手术治疗,包括开放手术组318例和腹腔镜手术组160例.比较两组手术时间、术中出血量、术后肠功能恢复时间、术后疼痛、术后住院天数及手术并发症等方面的差异.结果 开放手术组手术全部成功;腹腔镜手术组154例成功,6例中转开放后成功切除肿瘤.腹腔镜手术组切除肿瘤直径＞6 cm者9例,恶性肿瘤3例,随访3～20个月无复发或转移.两组平均手术时间分别为(112±16)min、(69±10)min,术中平均出血量分别为(286±23)ml、(56±10)ml,术后平均肠功能恢复时间分别为(66±7)h、(24±7)h,术后平均镇痛次数分别为(1.9±0.4)次、(0.5±0.1)次,平均住院天数分别为(10.3±1.1)d、(7.2±0.7)d,并发症发生率分别为40.3%、7.5%,差异有统计学意义(P=0.023,0.007,0.039,O.003,0.029,0.001).结论 腹腔镜肾上腺切除术在手术时间、术中出血量、术后肠功能恢复时间、术后痛疼、住院天数以及并发症发生率等方面均优于传统的开放手术,已成为大部分良性肾上腺疾病治疗的金标准,但在大体积和恶性肿瘤的治疗中仍存在一些限制,正确地选择手术适应证和完善的围手术处理至关重要.     

后腹腔镜手术切除结核性无功能肾与开放手术的临床比较

目的：探讨后腹腔镜手术切除结核性无功能肾的安全性与疗效。方法：将36例结核性无功能肾患者,按手术方式分为后腹腔镜组和开放手术组,比较两组手术时间、术中出血量、术后住院时间、并发症等方面的差异。结果：后腹腔镜组手术中转开放手术2例,开放手术组手术均获成功;后腹腔镜组肠功能恢复时间平均2．10天。显著少于开放手术组2．79天（P〈0．05）;镇痛剂使用平均0．71次,显著少于开放手术组1．87次（P〈0．05）。结论：后腹腔镜手术切除结核性无功能肾创伤小,恢复快,有学习曲线,安全可行。     

Comparison of retroperitoneoscopic nephrectomy versus open approaches to nonfunctioning tuberculous kidneys: a report of 44 cases

PURPOSE: We retrospectively investigated the advantages of retroperitoneoscopic nephrectomy for nonfunctioning tuberculous kidneys by comparing its clinical results, operative methods and skills with those of open nephrectomy. MATERIALS AND METHODS: Clinical data on 22 patients with nonfunctioning tuberculous kidneys who underwent retroperitoneoscopic nephrectomy, including simple and subcapsular nephrectomy, were compared with those on 22 who underwent open nephrectomy for a similar indication during the same period. Results in the 2 groups were analyzed. RESULTS: There was no statistical difference between the retroperitoneoscopy and open surgery groups with regard to patient age, sex or mean operative time +/- SD (93.0 +/- 12.6 vs 92.6 +/- 35.5 minutes). Mean blood loss was significantly less in the retroperitoneoscopy group than in the open surgery group (78.3 +/- 60.6 vs 160 +/- 120.0 ml). Mean hospital stay after operation was notably shorter in the retroperitoneoscopy group compared with the open surgery group (3.3 +/- 0.9 vs 9.1 +/- 0.8 days). The mean analgesic requirement for opioids and diclofenac sodium was also lower in the retroperitoneoscopy group than in the open surgery group (0 vs 2.1 +/- 0.9 and 5.2 +/- 1.1 vs 5.8 +/- 1.3 doses, respectively). CONCLUSIONS: Retroperitoneoscopic nephrectomy for renal tuberculosis has several advantages over open nephrectomy, namely a smaller wound, less blood loss and more rapid recovery. It may provide a safe and reliable method for treating refractory renal tuberculosis clinically.     

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.     

Laparoscopic nephroureterectomy for tuberculous nonfunctioning kidneys compared with laparoscopic nephroureterectomy for other diseases

OBJECTIVE: To summarize the results of 8 consecutive laparoscopic nephroureterectomies (LNUs) for tuberculous nonfunctioning kidneys and compare them with 10 LNUs performed for other benign etiologies (control group). MATERIALS AND METHODS: From November 1999 to February 2004, 8 patients underwent LNU for tuberculous ureteric stricture with a nonfunctioning kidney at our center. During the same time period, 10 LNUs were performed for other benign conditions. Hospital records were reviewed to obtain demographic data. In addition, operative time, intraoperative and postoperative complications, duration of postoperative ileus, and hospital stay was recorded. The outcomes of surgery for tuberculosis were compared with that for the control group. Patients were followed up for long-term complications of laparoscopic surgery. RESULTS: The two groups had a comparable demographic data. Nephroureterectomy was successfully performed laparoscopically in all 8 patients with tuberculosis. One patient in the control group, with a large staghorn renal and ureteral calculus, required conversion to open surgery due to dense perinephric adhesions. The outcome of surgery for tuberculosis was compared with outcomes in the control group using SPSS software. The mean operative time, blood loss, analgesic requirement, duration of postoperative ileus, and hospital stay of both groups was comparable, and the differences between them were statistically insignificant. CONCLUSION: The results of this study indicate that LNU for a tuberculous nonfunctioning kidney is a safe, effective, and less invasive treatment modality. Comparing our results with those of nephroureterectomy for other, benign diseases shows that the procedure has similar safety and efficacy even for tuberculous kidneys. Tuberculosis should not be considered a contraindication for a laparoscopic approach. Laparoscopic nephroureterectomy should be offered as the treatment modality of choice to all patients with tuberculous nonfunctioning kidney whose disease involves the kidney and ureters.     

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。     

结核性无功能肾的腹腔镜切除(附9例报告)

目的探讨后腹腔镜切除无功能结核肾的应用价值。方法我院2003年10月-2006年11月为9例肾结核行后腹腔镜下结核肾包膜外切除术。用超声刀游离肾脏与输尿管，Endo-GIA或Hem-o-10k阻断肾蒂，把肾放入肾袋后取出。结果9例均成功完成单纯肾切除。无一例中转开放手术，手术时间90—180min，平均110min。术中失血量20—200ml，平均94．4ml。术后住院时间3—8d，平均5．5d。术中1例肾包膜撕破造成少量干酪样脓液外渗，腹膜损伤1例。切口一期愈合。9例随访1—38个月，平均22个月，对侧肾功能正常。结论后腹腔镜结核肾切除术创伤小、出血少、恢复快，对于无功能结核肾是一种比较安全、可靠的手术方法。     

Retroperitoneoscopic pre-transplant native kidney nephrectomy

AIMS: Laparoscopic nephrectomy has become a standardized procedure for removal of benign non-functioning kidneys. We present our experience of retroperitoneoscopic pre-transplant native kidneys nephrectomy. METHODS: Comparison of 40 patients who underwent retroperitoneoscopy with 40 open simple pre-transplant nephrectomy patients was done. RESULTS: Forty retroperitoneoscopic nephrectomies were done between June 2003 and April 2005. The mean operative time was similar in the two groups; however, the mean blood loss, postoperative analgesic requirement, complication rate, hospital stay and convalescence period were significantly less in the retroperitoneoscopic group. CONCLUSION: Retroperitoneoscopic nephrectomy should be offered as the primary treatment modality to patients requiring pre-transplant native kidney nephrectomy, except in patients where it is contraindicated.     

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。     

腹膜后腹腔镜结核性无功能肾切除术与开放手术的比较

目的:比较腹膜后腹腔镜结核肾切除术与开放手术的治疗效果。方法:回顾分析49例结核肾患者的临床资料,腹膜后腹腔镜组23例,开放组26例,比较术中、术后各项指标。结果:49例均顺利完成手术,腹膜后腹腔镜组平均手术时间长于开放组(P0.05),术中出血少于开放组(P0.05),术后留置引流管时间、住院时间显著缩短(P0.05)。结论:与开放手术相比,腹膜后腹腔镜切除无功能结核肾患者创伤小,康复快,是治疗结核性无功能肾安全、有效的术式之一。     

后腹腔镜肾切除的临床研究

目的通过与开放性肾切除比较,评估后腹腔镜肾切除的临床应用价值。方法从2003年2月至2006年10月,我科行后腹腔镜肾切除26例,其中巨大肾积水12例,肾性高血压8例（5例先天性肾发育不良、3例外伤性肾萎缩）,肾盂肿瘤6例。同期开放手术36例,其中巨大肾积水22例,肾性高血压7例,肾盂肿瘤7例。记录腹腔镜组及开放组的手术时间、术中失血量、术后恢复时间、住院时间及术后应用止痛剂次数。结果腹腔镜手术组除1例因出血改为开放外,其余均顺利完成肾切除,开放手术亦均顺利完成。与开放手术相比,后腹腔镜肾切除除手术时间长外,术中出血量、术后应用止痛剂次数、术后恢复时间和住院时间均显著优于开放手术组。结论巨大肾积水致肾功丧失及肾性高血压需肾切除者应首选腹腔镜肾切除,特别是后腹腔镜手术,其可避免腹腔内并发症。对于小的肾盂肿瘤,应首先考虑腹腔镜肾切除,其可避免腰部切口,减少相应并发症。与开放手术相比,后腹腔镜肾切除具有创伤小、恢复快、出血少等优点,具有一定的临床应用价值。