完全性后腹腔镜下肾输尿管全长切除术治疗肾结核的临床体会

发布时间：2018-06-30 07:13

本文选题：肾结核 + 肾输尿管全长切除术　；参考：《中国内镜杂志》2017年04期

【摘要】：目的探讨完全性后腹腔镜下肾输尿管全长切除术治疗肾结核的可行性和安全性。方法选取该院2013年1月-2016年1月收治的肾结核病患者15例。其中,男12例,女3例,年龄36~64岁,平均47岁。所有患者根据病史、症状及术前辅助检查,包括经尿找抗酸杆菌、静脉尿路造影、CT等均确诊为肾结核,且经核素肾图检查明确为单侧结核性无功能或功能严重受损肾脏,对侧肾功能正常。术前常规给予三联抗结核药物治疗至少4周,确认无活动性肾外结核,红细胞沉降率恢复正常后行后腹腔镜下肾输尿管全长切除术,利用结扎夹或内镜用切割缝合器处理输尿管末端,实行患者不翻身情况下完全切除患侧肾及输尿管全程。结果 15例手术均获成功,无中转开放病例。手术时间75~138 min,平均109 min;术中出血量70~230 ml,平均157 ml;术后住院5~11 d,平均7 d。术中损伤肾静脉、腰静脉各1例,输尿管末端破裂1例,损伤腹膜3例,未出现术后切口感染及出血等并发症。术后继续抗结核治疗至少5个月,随访25个月,未发现结核复发病例,所有患者的尿路刺激症状消失,经尿找抗酸杆菌阴性,红细胞沉降率正常,复查B超未发现泌尿系统结核病灶残留。结论通过上述方法施行完全性后腹腔镜下肾输尿管全长切除术,无需改变患者体位及增加开放切口,创伤小,恢复快,安全可行。
[Abstract]:Objective to explore the feasibility and safety of complete retroperitoneal laparoscopic nephrectomy for renal tuberculosis. Methods 15 cases of renal tuberculosis treated in January -2016 January 2013 were selected. Among them, 12 men, 3 women, age 36~64, average 47 years old. All patients were diagnosed according to the medical history, symptoms and preoperative examination, including through urine search for resistance. Acid bacilli, intravenous urography, CT and so on were confirmed as renal tuberculosis, and the renal function was clearly defined as unilateral tuberculous nonfunctional or functional damaged kidneys with nuclide renogram. Three anti tuberculosis drugs were given for at least 4 weeks before operation to confirm inactive extra renal tuberculosis, and the erythrocyte sedimentation rate was restored to normal after normal laparoscopy. Complete resection of the lower ureter and ureter, using a ligation clip or endoscopic cutting suture to treat the ureter end, the whole course of the kidney and ureter was completely removed under the condition of the patient without turning over. The results were successful in 15 cases and no open cases. The operation time was 75~138 min, an average of 109 min; the amount of bleeding during the operation was 70~230 ml, with an average of 157 ml; after the operation, the operation was 157 ml. In 5~11 D, the renal vein was damaged in the average 7 d. operation, 1 cases of each lumbar vein, 1 cases of ureteral end rupture, 3 cases of injury peritoneum, no postoperative complications such as infection and bleeding. After the operation, the treatment continued to be treated for at least 5 months, followed up for 25 months, no recurrent cases of tuberculosis were found, the urinary tract irritation symptoms disappeared in all patients and found the acid bacilli through urine. Conclusion the complete retroperitoneal laparoscopic ureterectomy without changing the position of the patients and increasing the open incision, the trauma is small, the recovery is fast, and it is safe and feasible.
【作者单位】：广东省广州市番禺区何贤纪念医院(南方医科大学附属何贤纪念医院)泌尿外科;
【分类号】：R699.2

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