术中牵拉精索有助于辨别.doc

后腹腔镜上半肾输尿管切除术治疗成人重复肾畸形 杨明 杨远清 杨燮樵 李如兵 陈丽君 陈铁定 　 [摘要] 　目的:探讨后腹腔镜上半肾切除术治疗成人重复肾畸形的方法和疗效。方法:自2008年1月～2012 年12月,对26例重复肾畸形患者行后腹腔镜上半肾切除术。观察手术时间、术中出血量、术后早期恢复情况、并发症及手术疗效。结果:26例患者均顺利完成后腹腔镜上半肾切除术,手术时间为140 min (100～210 min) ,术中平均出血量为80 ml (40～130 ml) ,均未输血,术中未见明显并发症,术后住院时间平均6.8天,术后复查肾功能未见明显改变。术后3 天拔除导尿管并下床活动,负压引流管待引流量 20 ml 后拔除。1 例患者术后出现尿漏，选择性肾动脉栓塞后痊愈。术后随访6～18个月,无发热、腰酸及漏尿症状,复查B 超未发现肾周积液，排泄性尿路造影或者核磁共振尿路成像显示患者下半肾功能正常。结论: 后腹腔镜上半肾输尿管切除术是一种安全有效、创伤小、出血少、恢复快的微创治疗方法。 [关键词] 　后腹腔镜；肾部分切除；重复肾 　　 Retroperitoneoscopic upper pole partial nephrectomy for duplicated kidney in adult patients YANG Ming 　 YANG Yuanqing YANG Xieqiao LI Ring CHEN Li Jun CHEN Tie Ding Department of Urology , Li Huili Hospital , Medical College of Ningbo University , Ningbo ,315040 　Abstract 　Objective: To explore the technique and clinical efficacy of retroperitoneoscopic upper pole partial nephrectomy for duplicated kidney in adult patients。Methods: From January 2008 to December 2012 ,26 patients with duplicated kidney underwent retroperitoneoscopic upper pole partial nephrectomy in our institution. The operation time , estimated blood loss , postoperative recovery , complications and operative effect were recorded. Results: All procedure were successfully completed without open conversion. The mean surgical time was 140 minutes ( range from 100 to 210 min) . The mean estimated int raoperative blood loss was 80 ml ( range from 40 to 130 ml) with no blood transfusion. The mean postoperative stay was 6.8 days.One case required selective embolization of renal artery for urinary fistula There was no significant complication during the surgery with quick recovery after the surgery.During a duration of 6 - 18 month follow up , no pyrexy or other symptom was noted. No signal for urinoma was identified by ultrasonograph. Conclusion: Retroperitoneoscopic upper pole partial nephrectomy is a safe and effective technique with minimal invasion and should be offered as the treatment modality of choice to pati