Laparoscopic nephrectomy for nonfunctioning tuberculous kidney

BACKGROUND AND PURPOSE: Although laparoscopic nephrectomy for benign renal disease has been widely accepted, use of the operation for tubercular pyelonephritic kidney is relatively contraindicated because of difficulties in dissecting the dense fibrotic adhesions and the risk of spillage of caseous materials with subsequent dissemination of the disease. However, with the accumulation of experience, laparoscopic surgery is expanding its applications. In this study, we tried to evaluate the efficacy and safety of the laparoscopic nephrectomy for renal tuberculosis. PATIENTS AND METHODS: At three centers, 13 laparoscopic nephrectomies were performed between April 1996 and March 1999. The patients consisted of eight men and five women with a mean age of 44.8 years (range 37-51 years). All patients had known renal tuberculosis with a nonfunctioning kidney and underwent nephrectomy after at least 3 months of chemotherapy with four antituberculous drugs. Nine patients underwent the transperitoneal approach and four patients, the retroperitoneal approach. The follow-up was from 2 to 35 months with a mean of 15.8 months. RESULTS: Kidneys were removed laparoscopically in 12 patients (92%). The mean operative time was 268 minutes (range 190-500 minutes), and the mean estimated blood loss was 227 mL. Although there had been some difficulties releasing the adhesions, no significant intraoperative and postoperative complications were observed. Conversion to open surgery was needed in only one patient. The mean hospital stay was 4 days, and the patients returned to normal activity within 10 days. Neither local recurrence nor distant dissemination of the disease was observed during the follow-up period. CONCLUSION: Laparoscopic nephrectomy for renal tuberculosis was safe and effective with minor complications. Therefore, tuberculosis should not be a contraindication to a laparoscopic approach.     

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。     

Retroperitoneoscopic nephrectomy for nephrocolonic fistula due to tuberculous nonfunctioning kidney

AIM: The aim of this paper was to evaluate feasibility of retroperitoneoscopic nephrectomy in a patient with nephrocolonic fistula due to tuberculosis. MATERIALS AND METHODS: A 20-year-old female had presented with high-grade fever. Percutaneous drainage of the kidney for pyonephrosis was performed as an initial drainage procedure. Retrograde pyelography revealed a nephrocolonic fistula. Retroperitoneoscopic nephrectomy with intracorporeal suturing of the defect in the colon was performed. RESULTS: Operative time was 245 minutes and blood loss was 170 mL. Total hospital stay was 7 days. Histopathology of the removed kidney confirmed the diagnosis of tuberculosis. At 1 year of follow-up, she gained 5 kg of body weight after a complete course of antituberculous drugs. CONCLUSION: Retroperitoneoscopic nephrectomy for tuberculous nephrocolonic fistula is feasible and safe.     

Laparoscopic pyeloplasty as an alternative to nephrectomy in adults with poorly functioning kidneys due to ureteropelvic junction obstruction

International Urology and Nephrology - To evaluate outcomes of laparoscopic pyeloplasty (LP) in adults with poorly functioning kidney due to ureteropelvic junction obstruction (UPJO). A...     

后腹腔镜无功能肾切除术的临床体会(附16例报告)

目的:总结后腹腔镜无功能肾切除术的安全性及手术方法、技巧。方法:回顾分析2013年1月至2016年1月为16例无功能肾患者行后腹腔镜肾切除术的临床资料,观察术前患肾体积、手术时间、手术出血情况、术后并发症情况。结果:16例手术均完成,无一例中转开放手术。患肾直径20~200 mm,平均(102.5±11.3)mm;手术时间105~450 min,平均(208.1±24.1)min;术中出血量40~280 ml,平均(160.0±14.3)ml;术中、术后均未输血;术后发生不全性肠梗阻1例,予以灌肠后恢复;切口拆线后均愈合良好。结论:后腹腔镜无功能肾切除术中对肾动静脉的处理是手术关键。对于积水明显的肾脏可先吸出积水,缩小肾脏体积,沿肾脏边缘分离,这是保证手术安全可靠的方法;后腹腔镜无功能肾切除术后无明显并发症发生,是微创治疗的发展方向,值得进一步推广应用。     

后腹腔镜切除积水无功能肾17例

目的探讨后腹腔镜积水无功能肾切除术的手术方法和效果。方法对17例积水无功能肾患者行后腹腔镜积水无功能肾切除术。腰部3个Trocar穿刺入路,手指法建立后腹膜气腹,游离出部分病变肾脏后先将肾脏切开一小口,吸净积水肾内的积水,然后再游离肾脏,用钛夹或Hem-o-lok夹闭肾蒂血管后切断,切除患肾,留置腹膜后引流管。统计手术时间、术中出血量和术中、术后并发症及观察手术效果。结果17例手术均获得成功,手术时间为150．300min,平均为170min。术中出血10-80ml,平均30ml。引流管于术后2-3d拔除,无大出血、感染、腹膜破裂、腹腔脏器损伤等并发症。结论后腹腔镜积水无功能肾切除术是一种微创、安全、有效、恢复快的术式。     

腹腔镜肾部分切除术治疗肾门旁肾肿瘤(附14例报告)

目的:探讨及总结腹腔镜肾部分切除术治疗肾门旁肾肿瘤的疗效及经验.方法:2006年1月至2011年5月经腹腔镜肾部分切除术治疗14例肾门旁肾肿瘤,肿瘤直径平均2.4 cm.观察手术时间、热缺血时间、术中出血量、术中术后并发症、切缘阳性率等.结果:14例手术均顺利完成.热缺血时间平均27.6 min,术中出血量平均105 ...     

Laparoscopic pyelovesicostomy for ureteropelvic junction obstruction in a pelvic kidney

Pyelovesicostomy is an attractive option for treatment of ureteral obstruction in a congenital pelvic kidney or a renal allograft. We describe the first laparoscopic performance of this procedure. The total operative time was 207 minutes.     

后腹腔镜下无功能肾切除术临床研究(附32例报告)

Objectives To investigate the feasibility and the clinical effect of retroperitoneal laparoscopic nephrectomy. Methods Total 32 cases were performed retroperitoneal laparoscopic nephrectomy from June 2006 to Jan 2010, including 8 cases had hydronephrosis and non - functioning kidney with ureteropelvic junction obstruction,10 cases had hydmnephrosis and nonfunctioning kidney with calculi, 11 cases had nonfunctioning kidney with tuberculous and 3 cases had atrophyorenal. Results All operations were succeeded and effective. none changed to open operation during surgery. The operating time was 80 ～ 180 min with an average of (105±27)min;the blood loss volume was 20 ～210 mL, the mean blood loss was (95±15)mL;All patients were discharged 5 to 7 days after operation, the mean blood loss was (95 ± 15)mL. All patients did not receive blood transfusion and had no serivious complication. Conclusions Retroperitoneal laparoscopic nephrectomy for nonfunctioning kidney is proved to be efective with minimal invasion,quicker recovery procedre and less complication. It can be used as the perferred method of clinical simple nephrectomy.     

后腹腔镜下无功能肾切除术临床研究(附32例报告)

目的 探讨后腹腔镜无功能肾切除术的可行性及临床效果.方法 分析2006年6月～2010年1月行后腹腔镜无功能肾切除术32例临床资料(其中先天性肾盂输尿管连接部狭窄致肾积水无功能8例,结石梗阻致导致肾积水无功能10例,结核性无功能肾11例,萎缩肾3例).结果 32例均获成功,无中转开放者.本组手术时间80-180min,平均(105±27)min;出血量20～210mL,平均(95±15)mL;术后住院时间5～7天;术中及术后均未输血及发生严重并发症.结论 后腹腔镜下无功能肾切除术具有创伤小,疗效确切,术后恢复快,并发症少等优点,可作为临床单纯肾切除的首选治疗方法.     

后腹腔镜包膜下肾切除术治疗严重感染粘连性无功能肾(附12例报告)

目的　探讨后腹腔镜包膜下肾切除术治疗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　 12例患者 ,男 8例 ,女 4例。年龄 35～ 6 6岁 ,平均 4 1岁。肾结核 5例 ,肾急慢性感染 7例 ,其中肾积脓行肾穿刺造瘘或输尿管插管引流术后 6例。左侧 7例 ,右侧 5例。 12例患者均行后腹腔镜包膜下肾切除术。沿肾脏长轴切开增厚的肾包膜 ,肾包膜内游离肾实质 ,紧靠肾门处再次环形切开肾包膜 ,分离肾血管周围脂肪 ,使肾蒂组织薄到足以用直线切割吻合器离断 ,再离断肾蒂 ,切取肾脏 ,留置腹膜后引流管。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 ,无中转开放。手术时间 (82 .9± 2 2 .3)min ,术中出血量 (5 1.4± 12 .2 )ml,术后肠功能恢复时间 2 4～ 4 8h ,术后平均住院时间 7.5d ,术中及术后无明显并发症。随访 1～15个月 ,效果满意。　结论　该术式具有微创、出血少、恢复快、近期效果好等特点 ,较好地解决了感染性无功能肾脏与周围组织粘连严重时后腹腔镜肾切除的难题。但手术操作难度较大 ,术者需具备一定的腹腔镜手术经验。     

Laparoscopic nephrectomy for a nonfunctioning pelvic kidney in preparation for renal transplantation.

Pelvic kidneys pose a problem for any planned surgical intervention given their anomalous blood supply. Although minimally invasive approaches have been described for the management of benign conditions, only a handful of reports have described the use of laparoscopy for removal of ectopic or fused kidneys. We describe the laparoscopic removal of a symptomatic pelvic kidney in a patient before renal transplantation.     

单纯性腹腔镜肾切除术治疗良性无功能肾22例报告

目的:总结单纯性腹腔镜肾切除术治疗良性无功能肾的临床应用经验。方法:回顾分析2003年9月至2009年11月施行单纯性腹腔镜肾切除术治疗22例良性无功能肾患者的临床资料。先天性肾盂输尿管连接处狭窄12例,输尿管结石6例,慢性肾盂肾炎2例,肾结核2例。结果:22例手术均获成功,无中转开放手术。手术时间65~180min,平均90min,术中出血25~150ml,平均55ml。住院4~12d,平均5d。无严重并发症发生及输血病例。1例经腹膜后途径患者术后拔除引流管后局部形成腹膜后血肿,再次在B超引导下置管引流。结论:单纯性腹腔镜肾切除术治疗良性无功能肾安全、微创,耐心细致的手术操作和对不同疾病采取个性化的治疗方案是手术成功的关键。     

腹腔镜下肾盂翻瓣输尿管吻合术治疗二次肾盂输尿管连接部狭窄效果分析

目的 总结腹腔镜下肾盂翻瓣输尿管吻合术治疗二次肾盂输尿管连接部狭窄的安全性及有效性.方法 回顾性分析2018-02—2019-10间在扶沟县第二人民医院和郑州大学第一附属医院因二次肾盂输尿管连接部狭窄行腹腔镜下肾盂翻瓣输尿管吻合术治疗的15例患者的临床资料.狭窄段长度3～7 cm(中位数4 cm).患者均为中重度肾积水...     

Case report: retroperitoneoscopic nephrectomy in pyonephrotic nonfunctioning moiety of horseshoe kidney

Laparoscopic removal of the pyonephrotic moiety of a horseshoe kidney is challenging because of inflammation, aberrant vasculature, abnormal kidney location, and the renal isthmus. We herein report retroperitoneoscopic nephrectomy of the nonfunctioning pyonephrotic right moiety of a horseshoe kidney.     

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。     

腹膜后腹腔镜离断性肾盂成形术治疗肾盂输尿管连接部梗阻(附22例报告)

目的:总结腹膜后腹腔镜离断性肾盂成形术治疗肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UP-JO)的手术经验,以提高其手术技巧。方法:回顾分析为22例UPJO患者行腹腔镜离断性肾盂成形术的临床资料。术前均经影像学检查证实UPJO,并伴有不同程度的肾积水。结果:22例手术均获成功。手术时间平均(150±12.6)min,术中出血量平均(60±10.7)ml,术后平均住院(6.5±1.5)d,无并发症发生。随访3～24个月,手术侧肾盂输尿管连接部吻合口无狭窄,肾盂输尿管排尿功能好。结论:腹膜后腹腔镜离断性肾盂成形术治疗UPJO安全、有效,有望逐步替代开放性手术。