急性闭合性肾损伤腹腔镜肾切除术

目的：探讨急性闭合性肾损伤经后腹腔途径腹腔镜肾切除术的可行性。方法：回顾性分析3例急性闭合性肾损伤经后腹腔途径腹腔镜肾切除术患者的临床资料：男2例，女1例；1例体外碎石肾损伤，2例为外伤性肾损伤。超声提示肾破裂伴肾周高回声区，考虑为血肿。CT提示肾脏破裂伴肾周血肿，血肿局限于肾周筋膜内，1例造影剂外溢。3例均行腹腔镜肾切除术，结果：3例手术均顺利完成，手术时间85min（60～120min），出血量180ml（100～300m1）。术后病理检查提示肾脏破裂。结论：在腔镜技术熟练的前提下，选择性急性闭合性肾损伤且血肿局限于肾周筋膜内患者，在伤后1周内行腹腔镜肾切除可行。

Laparoscopic Nephrectomy Following Acute Blunt Renal Trauma

Objective:To discuss the feasibility of laparoscopic nephrectomy following acute blunt renal trauma. Methods:The data of three cases(2 men and 1 woman) of acute blunt renal trauma received laparoscopic nephrectomy were reviewed retrospectively.Three patients were referred to emergency room following traumatic renal trauma in 2 and ESWL in 1.Renal trauma were confirmed on computed tomography(CT),with large retroperitoneal hematoma.Contrast-enhanced scans demonstrated contrast extravasation in 1 patient.Results:Three patients were treated with laparoscopic nephrectomy without conversion to open.The mean operative time was 85 min(60- 120 min) and average estimated blood loss was 180 ml(100-300 ml).The pathology showed renal rupture in three cases.Conclusions:Based on skillful laparoscopic technique,laparoscopic nephrectomy following acute blunt renal trauma is feasible in carefully selected patients with hematoma contained by Gerota’s fascia.