本文選題：腎結(jié)核 + 腎輸尿管全長(zhǎng)切除術(shù)��； 參考：《中國(guó)內(nèi)鏡雜志》2017年04期

【摘要】：目的探討完全性后腹腔鏡下腎輸尿管全長(zhǎng)切除術(shù)治療腎結(jié)核的可行性和安全性。方法選取該院2013年1月-2016年1月收治的腎結(jié)核病患者15例。其中,男12例,女3例,年齡36~64歲,平均47歲。所有患者根據(jù)病史、癥狀及術(shù)前輔助檢查,包括經(jīng)尿找抗酸桿菌、靜脈尿路造影、CT等均確診為腎結(jié)核,且經(jīng)核素腎圖檢查明確為單側(cè)結(jié)核性無(wú)功能或功能嚴(yán)重受損腎臟,對(duì)側(cè)腎功能正常。術(shù)前常規(guī)給予三聯(lián)抗結(jié)核藥物治療至少4周,確認(rèn)無(wú)活動(dòng)性腎外結(jié)核,紅細(xì)胞沉降率恢復(fù)正常后行后腹腔鏡下腎輸尿管全長(zhǎng)切除術(shù),利用結(jié)扎夾或內(nèi)鏡用切割縫合器處理輸尿管末端,實(shí)行患者不翻身情況下完全切除患側(cè)腎及輸尿管全程。結(jié)果 15例手術(shù)均獲成功,無(wú)中轉(zhuǎn)開放病例。手術(shù)時(shí)間75~138 min,平均109 min;術(shù)中出血量70~230 ml,平均157 ml;術(shù)后住院5~11 d,平均7 d。術(shù)中損傷腎靜脈、腰靜脈各1例,輸尿管末端破裂1例,損傷腹膜3例,未出現(xiàn)術(shù)后切口感染及出血等并發(fā)癥。術(shù)后繼續(xù)抗結(jié)核治療至少5個(gè)月,隨訪25個(gè)月,未發(fā)現(xiàn)結(jié)核復(fù)發(fā)病例,所有患者的尿路刺激癥狀消失,經(jīng)尿找抗酸桿菌陰性,紅細(xì)胞沉降率正常,復(fù)查B超未發(fā)現(xiàn)泌尿系統(tǒng)結(jié)核病灶殘留。結(jié)論通過(guò)上述方法施行完全性后腹腔鏡下腎輸尿管全長(zhǎng)切除術(shù),無(wú)需改變患者體位及增加開放切口,創(chuàng)傷小,恢復(fù)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.
【作者單位】： 廣東省廣州市番禺區(qū)何賢紀(jì)念醫(yī)院(南方醫(yī)科大學(xué)附屬何賢紀(jì)念醫(yī)院)泌尿外科;
【分類號(hào)】：R699.2

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