后腹腔镜结核肾切除术32例报告

目的]总结经后腹腔镜下结核肾切除术的经验。方法]本组32例,男性19例,女性13例,平均年龄44岁,患肾均无功能,左侧20例,右侧12例,合并膀胱挛缩2例,对侧积水4例,附睾结核3例。抗痨治疗2～3周后,行后腹腔镜下结核肾切除术。结果]成功完成后腹腔镜下结核肾切除术31例,平均出血80ml,平均手术时间160min。因严重粘连并结核脓液较多外溢而中转开放手术1例。离断输尿管后,经下腹小切口行输尿管残段切除术7例,不离断输尿管,经下腹小切口行输尿管全长切除术8例;未切除输尿管残段17例,其中术后输尿管残段积脓感染,二期行输尿管残段切除术1例。伤口结核感染1例,换药6月后愈合。结论]①后腹腔镜结核肾切除术,微创安全,应可为首选术式。②Hem-o-lok处理肾动静脉较为可靠,而术前CTA检查,可指导肾动脉的术中处理。③部分病肾与周围粘连严重,可试行多层面结合的锐性分离切除。④如输尿管炎变较重,可暂不离断,加下腹小切口行整段输尿管切除,并完整取出肾输尿管标本。如输尿管病变不重,在正规抗结核药物治疗下,输尿管残段切除并非必须。

RETROPERITONEAL LAPAROSCOPIC NEPHRECTOMY FOR TUBERCULOSIS KIDNEY(REPORT OF 32 CASES)

Objective]To summarize from the experience of retroperitoneal laparoscopic nephrectomy for tuberculosis kidney.Methods]32 patients with nonfunctioning tuberculosis kidney were collected in our study,20 cases were on left side,12 cases were on right side,2 cases were complicated with bladder contracture,4 cases were complicated with contralateral hydronephrosis,and 3 cases were complicated with epididymis tuberculosis.The average age was 44 years old,19 cases were male and 13 cases were female.Retroperiton...