后腹腔镜下包膜内切除严重感染粘连性无功能肾的术式探讨

目的探讨后腹腔镜包膜内切除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9例患者，男5例，女4例。年龄38～61岁，平均46岁。肾结核5例，肾非特异性感染4例。左侧5例，右侧4例。9例均行后腹腔镜包膜内肾切除，沿肾脏长轴切开增厚的肾包膜，包膜内游离肾实质，紧靠肾门处再次环行切开肾包膜，分离肾血管周围脂肪，使肾蒂组织薄到足以用血管闭合系统（LigaSure）凝固肾动静脉。离断肾蒂，取出标本，留置腹膜后引流管。记录手术时间，术中出血量，术中术后并发症及恢复时间。结果9例手术均获成功。手术时间1．5—3．0h，平均2．2h；术中出血量40～120ml，平均70ml；术后胃肠功能恢复时间1—2d；术中及术后无明显并发症；术后住院6～8d。随访1～10个月，效果满意。结论该术式具有微创、出血少、恢复快、效果好等特点，较好地解决了严重感染粘连性无功能肾的肾蒂处理难题。

Retroperitoneoscopic intracapsular nephrectomy for infective nonfunctioning kidney with dense perinephric adhesion

Objective To evaluate the technical feasibility and clinical efficacy of retroperitoneoscopic intracapsular nephrectomy for infective nonfunctioning kidney with dense perinephric adhesion.Methods This series included 9 patients(5 men and 4 women;mean age,46 years,age range,38-61 years),of whom 5 were diagnosed with tuberculous pyonephrosis and 4 with non-specific infective pyonephrosis.Of the 9 patients,5 had the diseased kidneys on the left side and 4,on the right.Retroperitoneoscopic intracapsular nephrectomy was performed in them all.With the plasmakerritic bipolar system,the dense adhesion surrounding renal pedicle was separated,and the renal pedicle was cut off after renal artery and veins were coagulated by LigaSure.The retroperitoneal drainage catheter was placed.The operative time,blood loss,intra-and post-operative complications,intestinal function recovery,and operative efficacy were observed.Results The operation was successful in all 9 patients,with the operative time being 1.5-3.0 h(mean,2.2 h),blood loss 40-120 ml(mean,70 ml),and postoperative gastrointestinal function recovery time 1-2 d.No complication occurred during and after operation.The postoperative hospital stay was 6-8 d.Follow-up of 1-10 months showed satisfactory effects.Conclusions Retroperitoneoscopic intracapsular nephrectomy has the advantages of microtrauma,less blood loss,quicker recovery and better effects.Furthermore,it can overcome the difficulty of retroperitoneoscopic dissection and removal of infective nonfunctioning kidney that is tightly adhesive to surrounding tissues.