【摘要】 目的探讨腹腔镜在巨大肾积水保肾手术中的应用价值和初步临床经验。方法本组6例。男2例,女4例。年龄15~57岁,平均28岁。5例因腰部胀痛不适及腹部肿块就诊,1例妊娠4个月者于体检B超发现。其中先天性肾盂输尿管连接部(UPJ)梗阻3例,UPJ梗阻继发肾下盏多发结石2例,肾盂结石伴息肉形成1例。6例均合并巨大肾积水,左侧4例,右侧2例;肾积水量2250~8300ml,IVU均不显影。采用经腹腔途径腹腔镜施行解除肾盂出口梗阻、肾盂成形、肾裁剪及肾折叠固定术。结果6例手术均获成功,手术时间2.5~5.0h,出血量50~150ml,术后平均住院时间7.2d。术后3个月复查腹部B超:肾积水明显减轻者5例,肾窦分离为1.8、2.0、2.5、2.5、2.8cm,肾脏外形较正常略小者1例。术后3个月行IVU检查均出现不同程度显影。随访3个月~2年,逆行肾盂造影未发现肾盂输尿管吻合口明显狭窄。结论巨大肾积水保肾治疗采用腹腔镜技术有效、可行。更多还原

【Abstract】 Objective To evaluate the application and initial experience of laparoscopy in kidneypreserving surgery for savage giant hydronephrosis. Methods This series included 6 cases of savage gianthydronephrosis (2 men and 4 women;age range,15 -57 years;mean age,28 years).Of them 5 cases weredetected when visiting doctors due to flank pain,abdominal mass,and the rest one by B-ultrasound duringpregnancy.Four cases had hydronephrosis on the left;and 2 cases,on the right.The quantity of hydronephro-sis was 2250 -8300 ml,respectively.None had development on IVU examination.Of them,3 cases had con-genital ureteropelvic junction (UPJ) obstruction;2 had multiple stones in infracalices secondary to UPJ ob-struction;1 had stones in pelvis with polyp formation.Relieving obstruction,pyeloplasty,nephroplication andnephropexy were performed via laparoscope. Results All the operations were successful.The operativetime was 2.5 -5.0 h;the blood loss was 50 -150 ml,and the mean postoperative hospital stay was 7.2 d.The postoperative follow-up ranged from 3 to 24 months. Three months after operation,B-ultrasound showedthat giant hydronephrosis was markedly relieved in 5 cases (the renal sinus separation was 1.8 m,2.0 cm,2.5 cm,2.5 cm and 2.8cm,respectively),and in the rest 1 case the kidney was slightly smaller than nor-mal.IVU examination was performed every 3 months after operation, and different degrees of developmentappeared in all cases.During the follow-up,no obvious ureteropelvic anastomotic stricture was found on retro-grade pyelography (RGP). Conclusions The protective renal treatment via laparoscopy for savage gianthydronephrosis is a feasible and minimally invasive technique that provides the same clinical and radiograph-ic results as open operation.更多还原