后腹腔镜手术与开放手术治疗重复肾上位无功能肾的疗效对比

目的比较后腹腔镜与开放手术行上位肾切除治疗成人重复肾上位无功能肾的疗效并总结相关手术经验。方法回顾性分析17例行重复肾上位无功能肾切除术患者的临床资料,其中后腹腔镜手术组(A组)9例,开放手术组(B组)8例,比较两组患者的术中出血量、手术时间、肠道功能恢复时间、术后下床活动时间、住院时间以及相关并发症的发生情况。对比两种不同手术方式的临床疗效。结果所有患者均顺利完成手术,痊愈出院。其中A、B组术中平均出血量(57.0±16.3)ml vs.(54.5±14.2)ml,手术时间(148.0±26.4)min vs.(135.0±23.3)min,两组比较无统计学差异(P>0.05),肠道功能恢复时间为(8.7±1.8)h vs.(18.2±2.5)h,术后下床活动时间为(24.2±3.5)h vs.(39.1±4.9)h,术后住院时间为(5.2±2.1)d vs.(10.9±2.9)d,两组比较有显著差异(P<0.05),A组明显优于B组。A组术后发生乳糜漏1例,B组术后发生尿漏1例,均住院期间经保守治疗后治愈。出院后随访6～18月,无明显发热、腰酸及其它相关并发症,复查B超未见肾周积液。结论后腹腔镜下重复肾上位无功能肾切除术与开放手术相比临床疗效相当,但具有术后恢复快,住院时间短的优点,是重复肾上位无功能肾患者的一种理想的治疗方式。

Comparison of Retroperitoneal Laparoscopic Heminephrectomy and Open Nephrectomy for Upper Nonfunctional Kidney Accompanied by Duplicated Kidneys in Adult Patients

Abstract： Objective To compare the efficacy of the upper kidney resection with retroperitoneoseopic or open surgery treatment of adult patients with duplicated kidneys accompanied by an upper nonfunetioning kid- ney, and summarize the relevant surgical experiences. Methods A retrospective analysis of the clinical data about 17 renal duplication cases undergoing upper nonfunctioning kidney resection, including 11 males and 6 females, aged 18 to 77 years old. Retroperitoneoscopic surgery was done in group A with 9 cases, and open surgery was done in group B of 8 cases. Comparison was made of the two groups of patients with the mean blood loss, operative time, recovery of bowel function, postoperative off-bed time, hospitalization time and the occur- rence of complications. Results All operations were successfully completed without open conversion. In group A and group B, the mean estimated blood loss was （57.0±16.3 ）ml vs. （54.5 ± 14.2 ）ml （P 〉 0.05 ）, the mean operative time was （ 148.0 ± 26.4） rain vs. （ 135.0 ± 23.3 ） rain （ P 〉 0.05 ）, the intestinal function recovery time was （8.7 ±1.8 ） h vs. （ 18.2 ± 2.5 ） h （ P 〈 0.05 ）, the postoperative off-bed time was （24.2 ± 3.5 ） h vs. （ 39.1 ± 4.9 ） h （ P 〈 0.05 ） and the length of postoperative hospital stay was （ 5.2 ± 2.1 ） d vs.（10.9 ± 2.9）d（P 〈 0.05 ）. 1 case of postoperative chylous leakage occurred in group A and 1 case of postop- erative urinary leakage occurred in group B. The expectant treatment was adopted and the two cases all got healed. During a duriation of 6 to 18 months follow-up, no pyresy or other symptom was noted. No signal for urinoma was identified by ultrasonograph. Conclusion Retroperitoneal laparoscopic heminephrectomy is a safe and effective technique with minimal invasion and rapid postoperative recovery, which could be an ideal treatment to patients with duplicated kidneys in adult patients.