探讨后腹腔镜肾切除治疗结石所致重度积水无功能肾的临床观察.docVIP

精品论文 参考文献 探讨后腹腔镜肾切除治疗结石所致重度积水无功能肾的临床观察 五常市小山子镇卫生院 150211 摘要： 目的：研究分析后腹腔镜行结石所致重度积水无功能肾切除术的手术方法和临床效果。方法：此次研究的对象是选择32例结石所致重度积水无功能肾患者。将其临床资料进行回顾性分析，并行后腹腔镜患肾切除术。全部采取经腰部途径，建立后腹腔气腹，根据术中具体情况决定夹闭离断肾蒂血管及游离肾脏的先后。19例采取游离部分患肾，于患肾戳一小口吸去大部分肾内积水，再全部游离肾脏，用Hem-o-lok夹夹闭肾蒂血管后，序贯离断肾动静脉，切除患肾。13例先用Hem-o-lok夹夹闭肾蒂血管后，序贯离断肾动静脉后再游离肾脏，再考虑吸尽患肾积水。常规留置肾窝引流管。观察手术时间、术中出血量和术中、术后肠功能恢复和术中、术后并发症及手术效果。结果：32例手术均获得成功，无一例中转开放，手术时间为55～180 min，平均为（90.1plusmn;26.9）min；术中出血20～110 mL，平均（29.9plusmn;4.7）mL。术中、术后均未输血。引流管一般于术后2～3 d拔除，对于合并脓肾、手术创面大、肾周粘连紧密且渗液多者酌情延长引流管拔除时间。无大出血、腹膜破裂、感染、腹腔脏器损伤等并发症。结论：后腹腔镜肾切除治疗结石所致重度积水无功能肾是一种微创、安全、有效、恢复快的术式，术中可根据具体情况决定处理肾蒂血管的先后。 　　关键词： 后腹腔镜；无功能肾；泌尿系结石；肾切除 [Abstract] Objective：study laparoscopic stones caused by severe hydronephrosis without the operative technique and clinical results of functional nephrectomy. Methods：the study was to select 32 patients with severe water and non functional renal. The retrospective analysis of the clinical data of patients after laparoscopic nephrectomy，parallel. Take all the waist approach. After the establishment of gasless celiac，according to the specific circumstances of the operation decision clipped off sequence in the renal vascular pedicle and free of the kidney. 19 cases take the free part of the kidney，in the suffering of a small mouth suction to the majority of the kidney，and then all the free kidney，with Hem-o-lok clip to clip renal pedicle blood vessels，the sequential removal of the renal artery and vein，removal of kidney. 13 cases of the first use of Hem-o-lok clip to clip the renal pedicle vessels，sequential disconnection of the renal artery and vein after the re free of the kidney，and then consider the absorption of kidney. Conventional indwelling renal fossa drainage tube. Observe the amount of bleeding and operation time，intraoperative，postoperative intestinal function recovery and postoperative complications and surgery effect. Results：32 cases of surgery were successful，no case was converted to open surgery time was 55 ～ 180 min，wi