同期后腹腔镜肾盂离断成形术联合肾部分切除术的安全性观察

杨斌; 邱敏; 卢剑; 马潞林

doi:10.13201/j.issn.1001-1420.2017.08.018

同期后腹腔镜肾盂离断成形术联合肾部分切除术的安全性观察

- 北京大学第三医院泌尿外科(北京, 100191)

详细信息

通讯作者: 邱敏,E-mail:qm1868@sina.com

中图分类号: R699.2

收稿日期: 2016-07-07

Safety of one stage retroperitoneal laparoscopic pyeloplasty and partial nephrectomy

- Department of Urology, Peking University Third Hospital, Beijing, 100191, China

More Information

Corresponding author: QIU Min, E-mail: qm1868@sina.com

Received Date: 07 July 2016

摘要

摘要: 目的:探讨同期行后腹腔镜肾盂离断成形术及肾部分切除术的可行性及安全性。方法:患者,女,23岁。1年前曾行输尿管镜碎石术,术后40天拔除输尿管支架管后间断高热,予对症治疗,后来我院CT提示左肾盂输尿管交界段狭窄,左肾错构瘤(少脂型)可能性大。完善检查后手术治疗。患者先取截石位放置左侧输尿管支架管,后改为右侧卧位,于后腹腔镜下游离出肾动静脉及输尿管,术中发现肾盂输尿管连接部狭窄闭锁,将狭窄段切除后与成形的肾盂吻合。游离肾脏见左肾腹侧大小约3cm肿物,阻断肾动脉并完整切除肿物。结果:手术顺利,手术时间210min,左肾动脉阻断时间15min,出血量20ml,无输血。术后病理报告左肾错构瘤、输尿管黏膜慢性炎症。术后无明显并发症,短期随访无复发。结论:同期患有同侧肾盂输尿管连接部狭窄及肾肿瘤的情况较为罕见,同期手术可明显缩短总的手术时间,避免了二次手术对患者身体的伤害,并能节省医疗资源,整体来说优于分期手术。手术安全可行,但需要腹腔镜手术经验丰富的医生来进行。
- 肾盂离断成形术 /
- 肾盂输尿管连接部梗阻 /
- 肾部分切除术
Abstract: Objective:To investigate the feasibility and safety of one stage retroperitoneal laparoscopic pyeloplasty and partial nephrectomy for ureteropelvic junction obstruction (UPJO) combined with angiomyolipoma (AML). Method:We report a 23-year-old female with uronephrosis presenting as intermittent fever combined with renal AML in left kidney.She has a surgical history of flexible ureteroscopic lithotripsy for renal calculi located in UPJO one year ago.CT found intrarenal sinus UPJO combined with a 3cm AML (minimal fat type). We preformed a retroperitoneal laparoscopic pyeloplasty and partial nephrectomy in one stage.Result:Laparoscopic pyeloplasty and partial nephrectomy were successful.The tumor size was 3.0cm, the warm ischemia time was 15 minutes, and the estimated blood loss was 20 ml.The operative time was 3.5 hours, and the hospital stay was 5 days.Histopathologic examination confirmed ureteral chronic inflammation and renal AML.No postoperative complications developed, including blood transfusion, fever or nausea.Conclusion:Ipsilateral secondary intrarenal sinus UPJO and renal tumors are rare.One stage procedure can significantly shorten the hospital time, decrease the physical injury and reduce the cost of hospitalization.The result has shown that one stage retroperitoneal laparoscopic pyeloplasty and partial nephrectomy is feasible and safe.However, it can be technically challenging, and adequate previous experience in laparoscopic pyeloplasty is necessary.
- pyeloplasty /
- UPJO /
- partial nephrectomy

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