摘要
目的:探讨超声引导下经皮肾穿刺微造瘘在腹腔镜肾切除术治疗巨大肾积水中的应用效果。方法:回顾性分析因巨大肾积水行腹腔镜肾切除术的49例患者资料,男27例,女22例;左肾26例,右肾23例。所有患者术前均行泌尿系超声、静脉尿路造影、泌尿系CT等检查明确诊断为巨大肾积水。术前均应用一次性中心静脉导管在超声引导下行经皮肾穿刺微造瘘术,术前行引流液相关检测。49例均判断为患肾无功能或患肾为脓肾而行腹腔镜肾切除术。手术方式包括经阴道自然腔道内镜手术肾切除术、耻骨上辅助单孔腹腔镜肾切除术和后腹腔镜肾切除术,记录手术时间、术中失血量、术后24 h视觉模拟疼痛评分、下床活动时间、拔除引流管时间、切口拆线时间、术后住院时间等。结果:49例均顺利完成超声引导下经皮肾穿刺微造瘘术,引流1周后,中位肾小球滤过率为9.42(7.03~18.77) mL·min^(-1),中位引流液pH值7.3(6.5~8.5),中位引流液比重1.012(1.003~1.034),中位肾实质厚度为5(2~10) mm,均未发生穿刺通道出血、肾脏出血及其他副损伤等穿刺相关并发症。所有腹腔镜肾切除术均顺利完成,无中转开放手术,无增加工作通道。中位手术时间120(75~138) min,术中中位估计失血量90(60~210) mL。均未输血,术中无副损伤,术后24 h中位视觉模拟疼痛评分2(1~3)分,术后第1 d下床活动,术后第3~4 d拔除引流管,术后第7~8 d切口拆线,中位术后住院时间5(4~8) d。患者术后恢复顺利,切口愈合良好,术后复查肾功能与术前无显著变化。所有标本病理检查与术前诊断相符合。所有患者术后均获随访,中位随访时间9(8~12)月,均恢复良好。结论:巨大肾积水患者于腹腔镜肾切除术前行超声引导下经皮肾穿刺微造瘘术,能够客观、准确地评价患肾功能,减少手术并发症,降低手术难度,缩短手术时间。
Objective:To investigate the clinical application effect of ultrasound-guided min-percutaneous nephrostomy before laparoscopic nephrectomy for giant hydronephrosis.Methods:The data of 49 patients undergoing laparoscopic nephrectomy due to giant hydronephrosis were retrospectively analyzed,including 27 males and 22 females,26 cases were on the left side and 23 cases on the right side.All patients were diagnosed as giant hydronephrosis by urological ultrasonography,KUB+IVU and urological CT before surgery.They were performed ultrasound-guided min-percutaneous nephrostomy with central venous catheter before surgery.The drainage fluid was detected before operation.All 49 cases were diagnosed as non-function or pyonephrosis and underwent laparoscopic nephrectomy.The laparoscopic methods included transvaginal natural orifice transluminal endoscopic surgery nephrectomy(TVNOTES-N),suprapubic assisted laparoendoscopic single site surgery nephrectomy(SA-LESS-N)and retroperitoneal laparoscopic nephrectomy.The operation time,intraoperative blood loss,visual analogue pain score(VAS)at 24 hours after operation,ambulation time,drainage tube removal time,wound suture removal time,and postoperative hospital stay were recorded.Results:The ultrasound-guided min-percutaneous nephrostomy was successfully performed in the 49 patients.After 1 week of drainage,the median glomerular filtration rate was 9.42(7.03-18.77)mL·min^(-1),the median pH value of drainage fluid was 7.3(6.5-8.5),the median specific gravity of drainage fluid was 1.012(1.003-1.034),and the median renal parenteral thickness was 5(2-10)mm.No puncture related complications such as puncture channel hemorrhage,renal hemorrhage,and other collateral injuries occurred.All patients underwent nonfunctional nephrectomy successfully.No open surgery conversion,no need of additional ports occurred.The median operative time was 120(75-138)min.The median estimated blood loss was 90(60-210)mL.None of the patients received blood transfusion.There were no intraoperative complications.T
作者
刘林伟
邹毓华
邹晓峰
袁源湖
肖日海
伍耿青
张国玺
LIU Lin-wei;ZOU Yu-hua;ZOU Xiao-feng;YUAN Yuan-hu;XIAO Ri-hai;WU Geng-qing;ZHANG Guo-xi(Department of Urology,The First Affiliated Hospital of Gannan Medical University,Ganzhou,Jiangxi 341000)
出处
《赣南医学院学报》
2024年第3期230-234,共5页
JOURNAL OF GANNAN MEDICAL UNIVERSITY
基金
赣州市科技局科技创新人才项目(2022CXRC9593)。
关键词
经皮肾穿刺
腹腔镜肾切除术
巨大肾积水
超声引导
Min-percutaneous nephrostomy
Laparoscopic nephrectomy
Giant hydronephrosis
Ultrasound-guided
