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目的探讨后腹腔镜切除结核性无功能肾的有效性及安全性。方法2005年8月～2009年2月,对21例肾结核行后腹腔镜下肾切除术。用等离子钳游离肾脏与输尿管,Hem-o-lok阻断肾蒂,18例肾放入肾袋后取出,3例患侧下腹部取斜行切口处理输尿管及取肾。手术前后均行正规抗结核治疗。结果21例均成功完成肾切除,无一例中转开放手术,手术时间75～210min,平均105min。术中失血量40～220ml,平均100.5ml。术后住院时间4～9d,平均6.5d。术中3例肾包膜撕破造成少量干酪样脓液外渗,腹膜损伤5例。切口一期愈合20例,1例术后局部窦道形成,二次手术,输尿管残端切除术后治愈。随访3～24个月,平均12个月,6例因膀胱挛缩,术后3个月行结肠扩大膀胱术。结论后腹腔镜切除结核性无功能肾创伤小、恢复快,对于结核性无功能肾是一种安全、有效的手术方法。
Objective To investigate the effectiveness and safety of retroperitoneoscopic resection of tuberculous nonfunctional kidney. Methods From August 2005 to February 2009, 21 cases of renal tuberculosis underwent laparoscopic nephrectomy. Kidney and ureter were dissociated by plasma clamp, Hem-o-lok blocked renal pedicle, 18 cases of kidney were placed in kidney bag and removed. Three cases of lower abdomen were treated with oblique incision to treat ureter and kidney. Before and after surgery were regular anti-TB treatment. Results All the 21 cases were successfully performed the nephrectomy. None of them underwent open surgery. The operation time ranged from 75 to 210 minutes with an average of 105 minutes. Intraoperative blood loss 40 ~ 220ml, an average of 100.5ml. Postoperative hospital stay 4 ~ 9d, an average of 6.5d. Intraoperative 3 cases of renal capsule tear caused by a small amount of caseous pus extravasation, peritoneal injury in 5 cases. Incision incision in 20 cases, 1 case of local sinus formation, secondary surgery, ureteral stump resection cured. All the patients were followed up for 3-24 months with an average of 12 months. Six cases had bladder contracture, and colon augmentation was performed 3 months after operation. Conclusions Laparoscopic resection of tuberculous non-functional renal trauma is small, fast recovery, for non-functional tuberculosis tuberculosis is a safe and effective surgical method.