后腹腔镜下肾输尿管全长切除加经尿道膀胱袖状切除治疗肾结核的疗效分析

发布时间：2018-01-27 09:37

本文关键词： 肾结核后腹腔镜膀胱袖状切除　出处：《吉林大学》2014年硕士论文　论文类型：学位论文

【摘要】：泌尿系结核是继发于周身其余部位的结核病灶，肾结核是其中最主要的，近年来，伴随着结核病发病率的逐年不断的上升，尤其是不典型肾结核明显的增加了，给临床诊治带来一定困难[1-3]。肾结核因为有严重的肾周炎症、肾周及肾门处普遍的粘连，操作难度大，有结核播散的危险，术中出血量多，中转开放手术的几率高，曾以为是相对于腹腔镜手术的禁忌证[4]，伴随着腹腔镜技能的进步和临床医师经验、操作的不断提高，腹腔镜手术的技术在泌尿外科的普遍应用下日趋成熟，肾结核已不再是禁忌症，国内已有成功的文献报道[5]。腹腔镜下肾结核切除术中改为开放手术的主要因素是由于肾周围粘连严重，分离困难或伴有术中大出血的情况等。经腹膜后入路是相对于其它手术方式是安全可行的，创建有用的后腹膜间隙是手术能够成功的关键环节。张旭等[19]提出沿肾包膜甚至在包膜下游离患肾，然而一些专家认为沿肾周筋膜外游离患肾可避外粘连纤维化组织；考虑到越临近患肾．组织粘连越明显，我们选样在患肾脂肪囊外进行游离。输尿管末端开口处理的方法包括开放手术、经膀胱腹腔镜离断术、远端输尿管和袖状膀胱腹腔镜的装网技术、经尿道输尿管开口电切后腹腔镜拔除技术和输尿管套叠技术。现有文献并未报道哪种方法具有明显优势。腹腔镜术中先结扎输尿管等措施，尽可能防止在处理肾脏时结核菌的迁移，降低术后结核菌扩散复发的风险。我们认为本方法切除输尿管开口及膀胱壁内段疗效确切，最大程度减少患者创伤，康复快，效果显著。初期诊断和即时的确切治疗是治疗肾结核的首要环节,治疗方式务必符合具体情况的要求才能够获得良好的结果。后腹腔镜下肾输尿管全程切除加经尿道的膀胱袖状切除治疗肾结核，，手术安全、有效、易行的微创治疗方法，用电切镜环状切除输尿管开口及膀胱壁内段的输尿管，可完整的切除全程输尿管。对肾结核患者可很好的避免行下腹部开放切口的输尿管下段切除的术式，有效减少创伤，疗效显著。但是结核性肾切除是不是需要切除全长输尿管尚有争议，还需要多中心、大样本以及长期的随访考察予以进一步证实。
[Abstract]:The tuberculosis of the urinary system is the tuberculosis focus which is secondary to the rest of the body , and the kidney tuberculosis is the most important . In recent years , the incidence of tuberculosis has been increasing year by year , especially atypical renal tuberculosis . The primary factor in the replacement of open surgery in laparoscopic renal tuberculosis is due to the severity of adhesions surrounding the kidney , the difficulty of separation , or the presence of major bleeding during the procedure . Retroperitoneal access is a key link to the success of the procedure . The more obvious the tissue adhesion , we selected the free radical outside the kidney fat capsule . The procedure of end opening treatment of ureter includes open surgery , laparoscopic surgery of the bladder , laparoscopic removal of distal ureter and sleeve - like bladder , the removal of mycobacterium tuberculosis after transurethral resection of the ureter , and the risk of recurrence of mycobacterium tuberculosis . We believe that the method has definite curative effect on removing the ureter opening and the inner section of the bladder wall , and has the advantages of reducing the trauma of the patient , recovering quickly and remarkable effect . The early diagnosis and immediate exact treatment is the primary link in the treatment of renal tuberculosis .

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699

【参考文献】