腹膜后纤维化行腹腔镜输尿管松解腹腔内间置术1例报道

目的 探讨腹膜后纤维化所致肾积水腹腔镜治疗的可行性.方法 报告1例因腹膜后纤维化所致左肾积水行腹腔镜治疗的诊治过程和结果,结合文献复习,探讨采用腹腔镜方法治疗腹膜后纤维化所致肾积水的可行性.55岁女性,间断左下肢浮肿,伴恶心、呕吐5个月,化验检查提示血肌酐和尿素氮进行性上升,血肌酐最高达503μmol/L.CT提示右肾萎缩,左输尿管下段与髂血管相交处狭窄,腹主动脉前与髂内外血管周围软组织影包绕,其上输尿管扩张.术前予以左输尿管双J管置入,手术取右侧半卧位,分别采用脐下1 cm、4 cm和左侧腹外斜肌外侧相同水平2点穿刺置入穿刺套管,腹腔镜自脐下1 cm处套管置人,术中见后腹膜呈板状,灰白色,打开后腹膜,见左输尿管巾段与髂血管周围粘连严重,超声刀仔细分离长度约9 cm,分离松解输尿管与周围组织问粘连,上下各达无粘连处,将此段输尿管放入腹腔内,关闭后腹膜.结果 术后恢复好,5 d切凵拆线,术后1月拔除双J管,拔管后3 h出现腰痛、发热和少尿,予以解痉、镇痛和抗菌治疗2 d后逐渐好转,尿量正常,多次复查肾功能正常,B超提示左肾积水程度逐渐减轻.3个月后复查B超提示左肾积水程度较术前显著减轻,肾功能维持正常.结论 腹膜后纤维化行腹腔镜输尿管松解、腹腔内间置术具有微创、病人痛苦小、术后恢复快的优点.但因有关此种治疗的报告例数少、随访时间较短,今后还需要更多病例和长时间的随访来进行验证其治疗效果.

Laparoscopic ureterolysis for retroperitoneal fibrosis :one case report

Objective To investigate the feasibility of laparoscopic surgery for hydronephrosis caused by retroper-itoneal fibrosis.Methods Reported the diagnosis and treatment procedure and result of 1 case of hydronephrosis caused by retroperitoneal fibrosis on left side,who underwent laparoscopie surgery.Investigated the feasibility of hydronephrosis caused by retroperitoneal fibrosis with literature review.A 55-year-old female patient had interrupt-able left lower extremity swollen with nausea and vomiting for five months.The blood test showed progressive eleva-ting of creatinine and urea nitrogen.The highest creatinine value was 503 μmol/L.The computerized tomography showed renal atrophy on right side and there was a stenosis on crossing place between inferior segment on left ureter and iliac blood vessels,also there is a soft tissue image in front of aorta and around iliac blood vessels,the superior ureter was dilated.We set double J tube into left ureter before surgery with semi-reclining position toward right side,set trocar cannula through 1 era,4 em below the umbilicus as well as the same two points on lateral external oblique muscle of abdomen,set laparoscope from 1 cm below the umbilicus.We found the abdominal membrane pale and touch as tabular.There was serious eonglutination between middle segment ureter and around iliac blood vessels after we cut open retroperitoneal membrane.We carefully dissected the ureter for 9 cm and soluted the eonglutination a-round the ureter,then set the ureter into abdominal cavity and closed retroperitoneal membrane.Results The pa-tient recover well after surgery and sutured out after 5 days,pulled out the double J tube after I month.The patient had low back pain ,fever and oliguria after the double J tube was pulled out and recovered with spasmolysis,analge-sia and antibiosis treatment after 2 days.The voiding volume and renal function became normal.The B-type ultra-sound test showed hydronephrosis on left side was lessened.The ultrasound test after 3 months result showed hydro-nephrosis was significantly lessened than before surgery and renal function was normal.Conclusions The laparo-scopic ureterolysis surgery for retroperitoneal fibrosis is minimally invasive,less suffering and quick recovery.Be-cause of few case report and short follow-up time is more eases and long-term follow-up are needed to elucidate the therapeutic efficacy of this treatment.