后腹腔镜肾切除治疗结石所致重度积水无功能肾临床体会.docVIP

后腹腔镜肾切除治疗结石所致重度积水无功能肾临床体会 　　【摘要】 目的：探讨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体会。方法：对32例结石所致重度积水无功能肾患者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（90.1±26.9）min；术中出血20～110 mL，平均（29.9±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 　　The Clinical Experience on Retroperitoneal Laparoscopic Nephrectomy for the Treatment of Severe Hydronephrosis Caused by Calculi （Report of 32 Cases）/ZHU Zun-wei， XIONG Huan-teng， ZENG Tao.//Medical Innovation of China，2015，12（34）：143-146 　　【Abstract】 Objective： To investigate the retroperitoneal laparoscopic operation with severe hydronephrosis caused by calculi methods and clinical experience of nephrectomy. Method： 32 cases with calculi caused by severe hydronephrosis underwent retroperitoneal laparoscopic nephrectomyn， who all took 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. In 19 case， the free part of the kidney， and the kidney was a small mouth suction to most of the kidney， and then all the free kidney， with Hem-o-lok clip to close the renal pedicle blood vessels， the left renal artery and vein， to remove the kidney. 13 cases with Hem-o-lok used to clamp the renal pedicle blood vessels， then the renal artery was left off after the renal artery and the renal vein， conventional indwelling renal drainage tube. To observe the amount of bleeding and operation time， intraoperative， postoperative intestinal function recovery and intraoperative， postoperative complications and operation effect. Result： All the 32 cases were successful