腹腔镜肾折叠术治疗巨大肾积水(附12例报告)

目的　探讨腹腔镜肾折叠术治疗巨大肾积水的可行性及初步临床经验。　方法　巨大肾积水 12例。男 5例 ,女 7例。年龄 19～ 6 4岁 ,平均 4 3岁。左侧 7例 ,右侧 5例。输尿管上段结石4例 ,肾盂输尿管连接部 (UPJ)梗阻 2例 ,输尿管中段结石 2例 ,肾盂结石 3例 ,输尿管中段狭窄 1例。通过腹腔镜解除上尿路梗阻并于镜下用 2 0可吸收线“8”字缝合肾皮质 ,将肾脏中盏缝至上盏、下盏缝至中盏 ,折叠为拳头大小 ,并缝合肾周筋膜。　结果　 12例手术均取得成功。手术时间 75～ 2 10min ,术中出血 5 0～ 2 0 0ml。术后 1～ 4d肛门排气 ,1～ 3d拔除腹腔引流管 ,1周拔除导尿管并出院。术后 1个月于膀胱镜下拔除双J管 ,无尿漏 ,随访 3～ 18个月 ,无输尿管狭窄 ,IVU及经腹超声 (BUS)复查显示患肾积水明显减轻 ,核素电子断层扫描 (ECT)检查术侧肾脏肾小球滤过率 (GFR)好转 ,肾功能有不同程度恢复。　结论　腹腔镜肾折叠手术是巨大肾积水保肾手术的微创途径 ,不仅可以促进肾解剖和肾功能的恢复 ,加快尿囊内尿液排出 ,减少术后感染和结石的形成 ,创伤小、恢复快、痛苦少。

Laparoscopic renal plication for treatment of giant hydronephrosis(report of 12 cases)

Objective To describe the initial experience of transperitoneal laparoscopic renal plication for giant hydronephrosis,and to evaluate the clinical feasibility of the procedure. Methods This series included 12 cases of giant hydronephrosis (5 men and 7 women;age ranged from 19 to 64 years with a mean of 42.6 years).Of them 4 cases had upper ureter calculi;2 had ureteropelvic junction(UPJ) obstruction;2,middle ureter calculi;3,nephrolithiasis and 1,middle ureter stricture. The upper urinary tract obstruction was relieved and plication was performed via laparoscope. Results All the 12 operations were completed successfully.The intraoperative blood loss was 50 to 200 ml,operative time was 75 to 210 min.The postoperative follow-up lasted 3 to 18 months.In all these cases,hydronephrosis was relieved and renal function was improved. Conclusions Laparoscopic renal plication is an effective and minimally invasive method and can be considered as an alternative for treatment of giant hydronephrosis.