腹腔镜上半肾切除术治疗成人重复肾输尿管畸形

doi:10.19558/j.cnki.10-1020/r.2018.04.005

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摘要 目的: 探讨腹腔镜上半肾切除术治疗成人重复肾输尿管畸形的疗效。方法: 自2010年6月~2016年1月,对12例28~53岁的完全重复肾畸形的患者行腹腔镜上半肾切除术。其中9例行经后腹腔路径,3例行经腹腔路径。术前于重复肾下半肾正常输尿管置入输尿管导管1根。手术时,患者取45~90°健侧卧位并固定,经腹腔路径置入穿刺套管4处,经后腹腔路径置入穿刺套管3处。在远离肾门处游离重复肾上半肾输尿管。仔细分离供应重复肾上半肾的动脉血管并结扎,后用超声刀沿重复肾与正常肾实质分界处切除重复肾上半肾。结果: 12例患者均顺利完成手术,手术时间150~290 min,术中出血90~380 ml。经后腹腔路径较经腹腔路径术后肠道功能恢复时间短(53.4±16.2) vs. (62.3±12.7)h(P<0.05)。术后复查肾功能未见明显改变。术后住院7~10 d,平均8.6 d。术后随访3~12个月,无明显发热、腰痛及尿漏症状,复查B超未发现肾周积液。结论: 腹腔镜上半肾切除术治疗成人重复肾畸形可以通过经后腹腔路径和经腹腔路径两种方式,经后腹腔路径能尽快显露肾门、减少腹腔脏器损伤、加快肠道功能的早期恢复,并兼具美容效果。

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	柯为
	葛成国
	徐光勇
	姜庆
	张唯力
	刘川
	梁培禾
	杨小军
	罗旭

关键词 ：重复肾, 重复输尿管, 腹腔镜, 半肾切除术

Abstract：Objective: To investigate the curative effectivness of laparoscopic upper pole heminephrectomy in adult patients with the abnormalities of duplex kidney and ureter. Methods: A total of 12 patients with an age range of 28 to 53 years old underwent laparoscopic upper pole heminephrectomy between June 2010 to Jan. 2016. The key points of the technique included the placement of a catheter in the normal ureter at the beginning of the procedure. The patients were positioned in a 45-90 degrees lateral decubitus position and a 4-port transperitoneal or 3-port retroperitoneal technique was applied followed by the mobilization of the upper pole ureter away from the renal hilum. Afterwards, the vasculature supplying the upper pole was precisely ide.pngied and ligated. Followed by transection of the vasculature, the upper pole moiety was fully transected using the harmonic scalpel. Results: Nine patients were operated on using the retroperitoneal approach and 3 using the transperitoneal technique. The operation time ranged between 150 to 290 min with estimated blood loss of 90-380 mL. The patients with retroperitoneal approach had a shorter bowel movement recovery time than in those with transperitoneal approach [(53.4±16.2) vs. (62.3±12.7) h, P<0.05]. All of the patients were generally discharged on postoperative day 8.4 (range 7-10 d). There was no significant complication during the surgery with quick recovery after the surgery. Conclusions: Laparoscopic upper pole heminephrectomy for an ectopic ureter is safe and reproducible. Retroperitoneal approach can significantly reduce the risk of intra-abdominal organ injury and shorter bowel movement recovery time, with less dissection to reach the renal pedicle and a cosmetic result.

Key words： duplex kidney duplex ureter laparoscopy heminephrectomy

收稿日期: 2018-05-09

ZTFLH:

R692

通讯作者: 葛成国,kinghongyi@163.com

引用本文:

柯为, 葛成国, 徐光勇, 姜庆, 张唯力, 刘川, 梁培禾, 杨小军, 罗旭. 腹腔镜上半肾切除术治疗成人重复肾输尿管畸形[J]. 微创泌尿外科杂志, 2018, 7(4): 235-240.
Ke Wei, Ge Chengguo, Xu Guangyong, Jiang Qing, Zhang Weili, Liu Chuan, Liang Peihe, Yang Xiaojun, Luo Xu. Laparoscopic upper pole heminephrectomy in adults for treatment of abnormalities of duplex kidney and ureter. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2018, 7(4): 235-240.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1426.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2018/V7/I4/235

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