后腹腔镜肾实质切开取石术治疗复杂性肾结石的经验总结
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摘要
目的总结后腹腔镜肾实质切开取石术治疗复杂性肾结石的效果及手术技巧。方法 2010年1月~2016年3月本院对复杂肾结石患者实施后腹腔镜肾实质切开取石术23例。男15例,女8例,年龄32~75岁,平均52.6岁。结石长径0.8~5.5 cm,平均2.5 cm。结果 23例手术均成功完成,无中转开放手术者。手术时间40~180 min,平均87 min;9例患者未阻断肾动脉,14例患者肾动脉阻断14~39 min,平均27 min;术中失血量50~450 mL,平均160 mL,无输血病例。术中15例患者放置双J管,放置双J管时间3~8 min,平均4.2 min。术后血红蛋白较术前下降7~22 g/L,平均为10.9 g/L。术后1 d测血清肌酐19例较术前升高,4例较术前下降,平均升高12%。术后住院7~18 d,平均11.2 d。结论后腹腔镜肾实质切开取石术治疗复杂性肾结石安全有效。可吸收线单层缝合肾实质切实可靠。对于合并同侧肾上腺肿瘤、肾囊肿、肾盂旁囊肿等疾病的患者可作为首选。
Objective To evaluate the clinical efficacy and surgery techniques of retroperitoneal laparoscopic nephrolithotomy. Methods Retroperitoneal laparoscopic nephrolithotomywas performed in 23 cases(15 male and 8 female) from January 2010 to March 2016. The mean age of patients was 52.6 years(range 32-75 years). The mean long diameter of stone was 2.5 cm(0.8-5.5 cm). Results All the 23 surgeries were completed successfully without transferring open surgery. The mean operation time was 87 min(40-180 min). Renal artery was blocked in 14 cases, the mean renal warm ischemia time was 27 min(14-39 min). The mean intraoperative blood loss was 160 mL(50-450 mL), without blood transfusion. The mean D-J stent placing time was 4.2 min(3-8 min). The mean decreasing of hemoglobin was 10.9 g/L(7-22 g/L). The mean hospital stay was 11.2 days(7-18 days). Conclusion Retroperitoneal laparoscopic nephrolithotomy was safety and efficacy for complex renal calculi. Single-layer suture of renal parenchyma was reliable with absorbable suture. Retroperitoneal laparoscopic nephrolithotomy maybe the first choice for complex renal calculi with adrenal tumor, renal cyst andparapelvic cyst.
Objective To evaluate the clinical efficacy and surgery techniques of retroperitoneal laparoscopic nephrolithotomy. Methods Retroperitoneal laparoscopic nephrolithotomywas performed in 23 cases(15 male and 8 female) from January 2010 to March 2016. The mean age of patients was 52.6 years(range 32-75 years). The mean long diameter of stone was 2.5 cm(0.8-5.5 cm). Results All the 23 surgeries were completed successfully without transferring open surgery. The mean operation time was 87 min(40-180 min). Renal artery was blocked in 14 cases, the mean renal warm ischemia time was 27 min(14-39 min). The mean intraoperative blood loss was 160 mL(50-450 mL), without blood transfusion. The mean D-J stent placing time was 4.2 min(3-8 min). The mean decreasing of hemoglobin was 10.9 g/L(7-22 g/L). The mean hospital stay was 11.2 days(7-18 days). Conclusion Retroperitoneal laparoscopic nephrolithotomy was safety and efficacy for complex renal calculi. Single-layer suture of renal parenchyma was reliable with absorbable suture. Retroperitoneal laparoscopic nephrolithotomy maybe the first choice for complex renal calculi with adrenal tumor, renal cyst andparapelvic cyst.
引文
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[10]Armitage JN,Irving SO,Burgess NA.Percutaneous nephrolithotomy in the United Kingdom:Result of a prospective data registry[J].Eur Urol,2012,61(6):1188-1193.
[11]Chatahm J,Dykes T.Effect of percutaneous nephrolithotomy on differential renal function as measured by mercaptoacetyltriglycine nuclear renography[J].Urology,2002,59(4):522-526.
[12]Aminsharifi A,Irani D,Masoumi M,et al.The management of large staghorn renal stones by percutaneous versus laparoscopic versus open nephrolithotomy:a comparative analysis of clinical efficacy and functional outcome[J].Urolithiasis,2016,44(6):1-7.
[13]Simforoosh N,Radfar MH,Nouralizadeh A,et al.Laparoscopic anatrophicnephrolithotomy for management of staghorn renal calculi[J].J Laparoendosc Adv Surg Tech,2013,23(4):306-310.
[14]戴枫,糜远源,王建,等.斜侧卧位经皮肾微通道双镜指引下气压弹道联合钬激光治疗复杂性肾结石的疗效观察[J].现代泌尿外科杂志,2015,20(10):705-707.
[15]Stubbs AJ,Resnick MI.Struvite staghorn calculi in crossed fused ectopia[J].J Urol,1977,118(3):369-371.
[16]Morey AF,Nitahara KS,Mc Aninch JW.Modified anatrophicenphrolithotomy for management of staghorn calculi:Is renal function preserved?[J].J Urol,1999,162(3Pt1):670-673.
[17]Stage KH,Lewis S.Pre-and postoperative evaluation of renal function in patients with staghorn calculi utilizing quantitative renal scanning[J].Urology,1981,17(1):29-32.
[18]Giedelman C,Arriaga J,Carmona O,et al.Laparoscopic anatrothic Nephrolithotomy:Developments of the technique in the era of minimally invasive surgery[J].J Endourol,2012,26(5):444-450.
[2]Deger S,Tuellmann M,Schoenberger B,et al.Laparoscopic anatrophicnephrolithotomy[J].Scand J UrolNephrol,2004,38(3):263-265.
[3]Aminsharifi A,Hadian P,Boveriri K.Laparoscopic anatrophicnephrolithotomy for management of complete staghorn renal stone:Clinical efficacy and intermediate-term functional outcome[J].J Endourol,2013,27(5):573-578.
[4]El-Nahas AR,Eraky I,Shokeir AA,et al.Factors affecting stone-free rate and complication of percutaneous nephronlithotomy for treatment of staghorn stone[J].Urology,2012,79(6):1236-1241.
[5]El-Nahas AR,Eraky I,Shokeir AA,et al.Long-term results of percutaneous nephrolithotomy for treatment of staghorn stones[J].BJU Int,2011,108(5):750-754.
[6]Akman T,Binbay M,Sari E,et al.Factors affecting bleeding during percutaneous nephrolithotomy:Single surgeon experience[J].J Endourol,2011,25(2):327-333.
[7]胡卫国,唐宇哲,肖博,等.多镜联合一期治疗复杂性上尿路结石的疗效观察[J].临床泌尿外科杂志,2015,30(11):976-978.
[8]Michel MS,Trojan L,Rassweiler JJ.Complications in percutaneous nephrolithotomy[J].Eur Urol,2007,51(4):899-906.
[9]Desai M,De Lisa A,Turna B,et al.The clinical research office of the endourological society percutaneous nephrolithotomy global study:Staghorn versus nonstaghornstones[J].J Endourol,2011,25(8):1263-1268.
[10]Armitage JN,Irving SO,Burgess NA.Percutaneous nephrolithotomy in the United Kingdom:Result of a prospective data registry[J].Eur Urol,2012,61(6):1188-1193.
[11]Chatahm J,Dykes T.Effect of percutaneous nephrolithotomy on differential renal function as measured by mercaptoacetyltriglycine nuclear renography[J].Urology,2002,59(4):522-526.
[12]Aminsharifi A,Irani D,Masoumi M,et al.The management of large staghorn renal stones by percutaneous versus laparoscopic versus open nephrolithotomy:a comparative analysis of clinical efficacy and functional outcome[J].Urolithiasis,2016,44(6):1-7.
[13]Simforoosh N,Radfar MH,Nouralizadeh A,et al.Laparoscopic anatrophicnephrolithotomy for management of staghorn renal calculi[J].J Laparoendosc Adv Surg Tech,2013,23(4):306-310.
[14]戴枫,糜远源,王建,等.斜侧卧位经皮肾微通道双镜指引下气压弹道联合钬激光治疗复杂性肾结石的疗效观察[J].现代泌尿外科杂志,2015,20(10):705-707.
[15]Stubbs AJ,Resnick MI.Struvite staghorn calculi in crossed fused ectopia[J].J Urol,1977,118(3):369-371.
[16]Morey AF,Nitahara KS,Mc Aninch JW.Modified anatrophicenphrolithotomy for management of staghorn calculi:Is renal function preserved?[J].J Urol,1999,162(3Pt1):670-673.
[17]Stage KH,Lewis S.Pre-and postoperative evaluation of renal function in patients with staghorn calculi utilizing quantitative renal scanning[J].Urology,1981,17(1):29-32.
[18]Giedelman C,Arriaga J,Carmona O,et al.Laparoscopic anatrothic Nephrolithotomy:Developments of the technique in the era of minimally invasive surgery[J].J Endourol,2012,26(5):444-450.