3D模型打印联合机器人辅助腹腔镜行肾窦内肾盂切开取石术治疗鹿角形肾结石的初步临床研究(附3例报告)

目的:探讨3D模型打印联合机器人辅助腹腔镜行肾窦内肾盂切开取石术治疗鹿角形肾结石的可行性和安全性。方法:回顾性分析2016年11月~2017年10月收治的3例鹿角形肾结石患者的临床资料,3例患者均在术前进行3D模型打印,并结合模型设计手术方案,然后行机器人辅助腹腔镜肾窦内肾盂切开取石术。结果:3例患者均顺利完成手术,无明显并发症发生。手术时间125~260min;术中出血量30~80ml;术后引流量60~120ml;术后引流时间2~4d;术后住院时间5~8d。复查泌尿系平片有1例患者肾上盏结石残留,结石直径约为1cm,术后1个月行输尿管软镜碎石术治愈。结论:3D模型打印联合机器人辅助腹腔镜行肾窦内肾盂切开取石术治疗鹿角形肾结石安全可行,可以作为经皮肾镜取石术(PCNL)的有益补充。     

后腹腔镜肾窦内肾盂切开取石术治疗肾盂单发结石38例效果观察

目的探讨后腹腔镜肾窦内肾盂切开取石术治疗肾盂单发结石的效果。方法依据不同术式将75例肾盂单发结石患者分为2组。对照组37例采用经皮肾镜碎石取石术,观察组38例采用后腹腔镜肾窦内肾盂切开取石术。比较2组的治疗效果。结果 2组手术时间差异无统计学意义(P0.05)。观察组术中出血量、住院时间、并发症发生率及取石成功率均优于对照组,差异均有统计学意义(P0.05)。结论后腹腔镜肾窦内肾盂切开取石术治疗肾盂单发结石,取石成功率高、术中出血少、术后并发症少,可缩短患者住院时间。     

肾窦内肾盂加肾后下段间切开治疗复杂鹿角形肾结石

目的　提高复杂鹿角形肾结石的手术疗效。方法　分析总结 36例复杂鹿角形肾结石患者行肾窦内肾盂加肾后下段间区切开取石术的临床资料。结果　 36例均取石成功 ,术后康复顺利。随访 32例 ,5例肾盏内残留小结石 (<0 .5cm)。结论　肾窦内肾盂加肾后下段间区切开取石术操作简便 ,对肾脏损伤小 ,效果满意。     

肾窦内肾盂切开取石术治疗巨大鹿角形肾结石

目的　提高手术治疗巨大鹿角形肾结石的疗效。　方法　采用肾窦内肾盂切开取石术治疗巨大鹿角形肾结石患者 2 2例。　结果　 2 2例患者均取石成功。平均手术时间 116min ;术中需输血者 8例 ,平均输血量 5 5 0ml。无术后继发出血和感染等并发症。 12例术后 2～ 6个月内复查B超 ,3例肾内残余结石 ,直径均 <0 .8cm。　结论　肾窦内肾盂切开取石术治疗巨大鹿角形肾结石效果满意 ,操作简便、安全、易掌握     

肾窦内肾盂切开及肾后唇切开取石术治疗巨大鹿角形肾结石

目的 :提高手术治疗巨大鹿角形肾结石的疗效。方法 :采用肾窦内肾盂切开及肾后唇切开取石术治疗巨大鹿角形肾结石患者 2 3例。结果 :2 3例患者均取石成功 ,平均手术时间 116min ,术中需输血者 4例 ,平均输血量 40 0ml。无术后继发出血和感染等并发症。结论 :肾窦内肾盂切开及肾后唇切开取石术治疗巨大鹿角形肾结石效果满意 ,操作简便、安全 ,易掌握     

腹膜后腹腔镜肾窦内肾盂切开取石术17例报告

目的:探讨腹膜后腹腔镜肾窦内肾盂切开取石术的初步临床经验及手术疗效。方法:回顾分析2009年1月至2012年10月为17例肾结石患者经后腹腔途径行腹腔镜肾窦内肾盂切开取石术的临床资料。其中男14例,女3例;平均(45.6±8.9)岁;结石直径平均(2.6±0.9)cm。结石位于左侧11例、右侧6例,双肾结石4例,合并输尿管结石5例。结果:17例手术均获成功,手术时间平均(121.0±43.1)min,术中出血量平均(67.5±30.8)ml,术后平均住院(5.1±1.7)d,留置双J管4周。平均随访(18.0±6.4)个月,尿路平片及静脉尿路造影提示,2例患者分别于肾下盏残留0.6 cm及0.7 cm结石,余者均无结石残留,无一例肾盂出口输尿管狭窄。结论:腹膜后腹腔镜肾窦内肾盂切开取石术治疗肾结石是可行、安全、有效的。对于需保留肾单位(如孤立肾、单个肾)、严重感染、合并同期上尿路其他病症、不适合经皮肾镜取石的患者,可考虑替代开放手术。     

后腹腔镜下肾窦内肾盂切开取石术:附13例报告

目的 探讨后腹腔镜下肾窦内肾盂切开取石治疗肾鹿角状及多发性结石的疗效.方法 肾多发及鹿角状结石患者13 例,其中男8 例,女5 例.平均年龄41 岁.结石直经1.8耀2.7 cm.常规采用3 个Trocar,于腹膜后间隙建立气腹,紧贴肾盂外膜向肾窦内分离,暴露出肾盏漏斗部,切开取石,输尿管内置入双J 管,4-0 可吸收线缝合肾盂切口,冲洗、放置引流管.术后5耀6 d 拔出引流管.4 周左右拔出双J 管.结果 13 例手术均获成功,平均手术时间96 min.术后平均住院7 d.随访3耀18 个月,腹部平片(KUB)及静脉肾盂造影(IVU)示无结石残留,肾盂出口输尿管无狭窄,双肾输尿管均显影.结论 腹腔镜下肾窦内肾盂切开取石术是治疗肾结石可选择的一种微创手术,该术式能同期处理上尿路合并症,可部分替代开放性手术.     

复杂性肾结石不同开放手术疗效比较

目的评价不同的开放性手术治疗复杂性肾结石的疗效,以期降低结石残留率及保护肾功能. 方法回顾性分析采用不同术式治疗154例复杂性结石的临床资料,比较结石取净率、阻断肾血流时间及术后肾功能恢复情况. 结果肾窦内肾盂切开取石61例、肾盂 肾放射状切开取石18例、肾盂肾下段切开取石11例、肾盂肾实质(多处、小切口)切开取石42例、肾实质Brodel线剖开取石10例及肾部分切除术12例,阻断肾血流的时间平均分别为0、31、36、45、162及28 min.肾功能恢复情况:12例肾部分切除取石术肾功能恢复良好,肾窦内肾盂切开取石术、肾盂肾下段切开取石术、肾实质Brodel线剖开取石术各有1例未恢复,肾盂 肾放射状切开取石术有2例、肾盂肾实质多处、小切口切开取石术有6例未恢复. 结论对复杂性肾结石开放手术需根据结石的大小、肾盂形态、积水程度、所需时间及难度确定术式,同时选择静注肌苷或(/和)局部低温下进行.尽可能选用对肾功能损害小的肾窦内肾盂切开取石术或加作肾实质切口,减少肾实质Brodel线剖开取石术的应用.     

4种术式治疗孤立肾复杂性结石比较(附72例报告)

目的探讨治疗孤立肾复杂性结石的适宜手术方式. 方法回顾性分析肾窦内肾盂切开取石术(术式1)、肾盂、肾实质切开取石术(术式2)、无萎缩性肾实质切开取石术(术式3)、肾盂切开气压弹道碎石术(术式4)等4种不同术式治疗72例孤立肾复杂性结石的临床资料,依据手术时间、术后住院天数、住院费用、结石清除率、手术并发症及肾功能改善情况评价其优缺点. 结果术式1、2、3、4中结石清除率分别为93.75%(15/16)、88.23%(15/17)、84.61%(11/13)、96.15%(25/26),输血例数分别为0、6、8、0例;21例肾功能不全患者分别采用术式2、3、4,其手术后肾功能恢复时间分别为3月、3月、2周. 结论肾窦内肾盂切开取石术是治疗孤立肾中小型复杂性结石的基本方法之一,肾盂切开气压弹道碎石术是治疗巨型复杂性孤立肾结石的最佳手术选择.     

肾窦内肾盂加肾后唇切开术治疗鹿角状肾结石

目的探讨肾窦内肾盂加肾后唇切开术治疗鹿角状肾结石的疗效。方法鹿角状肾结石患者40例，单侧36侧，双侧4侧，肾盂均为肾内型，肾实质无明显萎缩，肾功能均正常，均施行肾窦内肾盂加肾后唇中下段无血管区切开取石术。结果本组均在常温下手术，未阻断肾蒂，结石均安全取出，无术中严重并发症发生。平均手术时间115(90～140)min，平均失血量为100(90～120)ml，术后1月拔除双J管，复查3例(7．5％)有肾盂内小结石残留。结论肾窦内肾盂加肾后唇中下段区切开取石术适合肾鹿角状结石的治疗．具有操作较简单、易掌握．取石容易且结石一次性取出率高，出血少的优点。     

Retroperitoneal pyelolithotomy for management of renal calculi.

OBJECTIVE: We evaluated the role of retroperitoneoscopic pyelolithotomy in the management of renal calculi. METHODS: Fifty-six cases (male, 27; female, 29) of solitary or multiple renal calculi were evaluated in the study. There were 46 patients with a single calculus, 4 patients with a staghorn calculus, and 6 with a caliceal calculus. Retroperitoneoscopic pyelolithotomy was carried out after creating a retroperitoneal space with the balloon dissection method. Pneumoretroperitoneum was maintained by carbon dioxide insufflation. RESULTS: Stone clearance was achieved in all cases barring 2 cases of caliceal calculi that were converted to the open procedure. The postoperative hospital stay averaged 4 days. Patients were ambulatory within 24 hours and back to work within 7 days on average. Complications encountered were peritoneal rent, subcutaneous emphysema, and superficial wound infection. The postoperative analgesic requirement averaged 100 mg of diclofenac (2 tablets). CONCLUSIONS: Retroperitoneoscopic pyelolithotomy is a safe, simple, and effective minimally invasive procedure and is a feasible option that can be recommended for management of renal calculi.     

复杂性肾结石的开放手术治疗(附51例报告)

采用开放性手术治疗复杂性肾结石51例，结果发现8例结石残留，无死亡病例。认为肾盂包括肾窦内肾盂切开是手术治疗复杂性肾结石首选的基本术式；肾窦内肾盂加肾后基段间区实质切开是取出巨大鹿角形结石较合理的肾切口。     

后腹腔镜输尿管上段复杂性结石切开取石术中结石移位的预防与处理

目的 探讨后腹腔镜输尿管上段复杂性结石切开取石术中结石移位的预防与处理。方法 回顾性分析13例复杂性输尿管上段结石行后腹腔镜输尿管切开取石术中结石移位患者的临床资料。结果 10例结石移位入肾盂,2例结石移位入肾上盏,1例移位入肾中盏。10例患者使用套石篮取石成功,3例患者使用输尿管软镜取出结石。结论 直接套石篮取石,必要时使用输尿管软镜可以有效处理后腹腔镜输尿管上段复杂性结石切开取石术中结石移位。
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腹膜后腹腔镜手术在泌尿外科重建手术中的应用（附258例报告）

目的：评价腹膜后腹腔镜手术用于泌尿外科重建手术的疗效、安全性,并总结治疗体会。方法：应用腹膜后腹腔镜手术行肾部分切除术54例,肾固定术26例,肾盂切开取石术12例,肾盂成形术82例,输尿管切开取石术84例。结果：254例成功,4例中转开放手术。手术时间30~150min,平均80min,术中出血20~400ml,平均150ml。术后住院4~23d,平均14d。无严重并发症发生。结论：腹膜后腹腔镜重建手术治疗泌尿外科疾病安全、有效,患者创伤小,痛苦轻,术后康复快。     

后腹腔镜肾盂输尿管切开取石术(附81例报告)

目的　评价后腹腔镜肾盂输尿管切开取石术治疗肾盂及输尿管中上段结石的应用价值。　方法　施行后腹腔镜肾盂输尿管切开取石术 81例 88侧。男 5 1例 ,女 30例。年龄 12～ 6 5岁 ,平均 36岁。结石直径 0 .8～ 3.0cm。左侧 4 1例 ,右侧 33例 ,双侧 7例。其中肾盂结石 11例 ,输尿管上段结石 6 8例 ,中段 2例。 3例为输尿管阴性结石。 2 1例曾行体外冲击波碎石术 (ESWL)或经输尿管镜气压弹道碎石术 (URL)或两者联合治疗 ;1例曾行经皮肾镜取石术 (MPCNL)、1例行URL致输尿管穿孔 ,中转腹腔镜手术。　结果　结石均一次取净。手术时间 30～ 2 10min ,平均 6 5min ;术中出血量 10～ 6 0ml,平均 2 5ml。 30例合并其他泌尿系疾病者术中一并施行后腹腔镜手术治疗。术后住院时间 4～ 10d。 6 0例获随访 1～ 16个月 ,无结石复发。　结论　后腹腔镜肾盂输尿管切开取石术可成为较大、质硬、阴性、慢性嵌顿性肾盂输尿管上段结石 ,尤其在孤立肾时的一线治疗 ;可作为ESWL和腔内治疗失败的补救治疗措施 ;并可同期行腹腔镜手术治疗并发疾病。     

肾窦内肾盂加肾实质联合切口治疗复杂性肾结石

目的 探讨治疗复杂性肾结石的手术方法。方法 对采用肾窦内肾盂加肾实质联合切开术治疗的36例复杂性肾结石患者的临床资料进行回顾性分析。结果 肾结石全部取净,术中不需要阻断肾蒂及局部低温处理、平均水中出血300ml,平均手术时间120min。术后B超或KUB检查,4例患者肾内有残余结石。结论 本手术方式符合肾动脉及其分支的解剖,肾损伤最小,手术步骤简单,易掌握,术中出血少,易取净结石,是较为合理的手术方法。     

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.     

经腹膜后腹腔镜囊肿去顶术治疗肾囊肿的初步体会

目的：总结经腹膜后腹腔镜囊肿去顶术治疗单纯性肾囊肿的经验，讨论手术适应证和手术要点，方法：采用经腹膜后腹腔镜囊肿去顶术治疗肾囊肿患者32例，结果：31例手术成功，1例转为开放手术，微小并发症发生率为16％，技术熟练后无并发症发生，1例术后3个月复发，术后平均住院3天，结论：经腹膜后腹腔镜囊肿去顶术创伤小，患者康复快，宜为肾囊肿外科治疗的首选术式。     

Retroperitoneoscopic nephron-sparing surgery of renal tumor using a microwave tissue coagulator without renal ischemia: comparison with open procedure

PURPOSE: It is ideal to use not a transperitoneal but a retroperitoneal approach for both open and endoscopic partial nephrectomy. We compared the results of retroperitoneoscopic nephron-sparing surgery for small renal tumors using a microwave tissue coagulator without renal pedicle clamping with those of a retroperitoneal open procedure. PATIENTS AND METHODS: Between 1996 and 2002, eight patients with small renal tumors underwent retroperitoneoscopic partial nephrectomy without renal ischemia, and nine patients with small renal tumors underwent open partial nephrectomy via a retroperitoneal approach. Both groups were operated on using a microwave tissue coagulator. RESULTS: Retroperitoneoscopic partial nephrectomy without renal ischemia was performed without any major or minor complications in any patient. The mean operation time for retroperitoneoscopic surgery was significantly longer than that for open partial nephrectomy (221.9 minutes v 145.9 minutes; P = 0.0004). However, the mean estimated blood loss for retroperitoneoscopic surgery was less than that for open partial nephrectomy (137.5 mL v 334.8 mL; P = 0.012). In addition, the retroperitoneoscopic group seemed to recover more rapidly than the open surgery group. CONCLUSIONS: Retroperitoneoscopic nephron-sparing surgery of small renal tumors using a microwave tissue coagulator without renal ischemia is feasible as minimally invasive procedure. It results in saving renal function, minimal blood loss, and rapid recovery.