探讨后腹腔镜肾切除治疗结石所致重度积水无功能肾的临床观察.doc

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1、探讨后腹腔镜肾切除治疗结石所致重度积水无功能肾的临床观察五常市小山子镇卫生院150211摘要：日的：研究分析后腹腔镜行结石所致重度积水无功能肾切除术的手术方法和临床效果。方法：此次研究的对象是选择32例结石所致重度积水无功能肾患者。将其临床资料进行冋顾性分析，并行后腹腔镜患肾切除术。全部采取经腰部途径，建立后腹腔气腹，根据术中具体情况决定夹闭离断肾蒂血管及游离肾脏的先后。19例采取游离部分患肾，于患肾戳一小口吸去大部分肾内积水，再全部游离肾脏，用Hem-o-lok夹夹闭肾蒂血管后，序贯离断肾动静脉，切除患肾。13例先用Hem-o-lok夹夹闭肾蒂血管后，序贯离断肾

2、动静脉后再游离肾脏，再考虑吸尽患肾积水。常规留置肾窝引流管。观察手术时间、术中出血量和术中、术后肠功能恢复和术中、术后并发症及手术效果。结果：32例手术均获得成功，无一例中转开放，手术时间为55〜180min,平均为(90.1±26.9)min；术中出血20〜110mL,平均(29.9±4.7)mLo术中、术后均未输血。引流管一般于术后2〜3d拔除，对于合并脓肾、手术创面大、肾周粘连紧密且渗液多者酌情延长引流管拔除时间。无大出血、腹膜破裂、感染、腹腔脏器损伤等并发症。结论：后腹腔镜肾切除治疗结石所致重度积水无功能肾是一种微创、安全、有效

3、、恢复快的术式，术中可根据具体情况决定处理肾蒂血管的先后。关键词：后腹腔镜；无功能肾；泌尿系结石；肾切除[Abstract]Objective：studylaparoscopicstonescausedbyseverehydronephrosiswithouttheoperativetechniqueandclinicalresultsoffunctionalnephrectomy.Methods：thestudywastoselect32patientswithseverewaterandnonfunctionalrenal.Theretrospectivean

4、alysisoftheclinicaldataofpatientsafterlaparoscopicnephrectomy,parallel.Takeallthewaistapproach.Aftertheestablishmentofgaslessceliac,accordingtothespecificcircumstancesoftheoperationdecisionclippedoffsequeneeintherenalvascularpedicleandfreeofthekidney.19casestakethefreepartofthekidney,

5、inthesufferingofasmallmouthsuctiontothemajorityofthekidney,andthenallthefreekidney,withHem-o-lokcliptocliprenalpediclebloodvessels,thesequentialremovaloftherenalarteryandvein,removalofkidney.13casesofthefirstuseofHem-o-lokcliptocliptherenalpediclevessels,sequentialdisconnectionofthere

6、nalarteryandveinaftertherefreeofthekidney，andthenconsidertheabsorptionofkidney.Conventionalindwellingrenalfossadrainagetube.Observetheamountofbleedingandoperationtime,intraoperative,postoperativeintestinalfunctionrecoveryandpostoperativecomplicationsandsurgeryeffect.Results：32casesofs

7、urgeryweresuccessful,nocasewasconvertedtoopensurgerytimewas55〜180min,withanaverageof(90.1+26.9)min；intraoperativebleeding20〜110mL,average(29.9+4.7)mL.Nobloodtransfusionduringoperationandafteroperation.Drainagetubegenerallyafter2〜3daysremoved,forcombinedwithrenalabscess,surgicalwound，p

8、erire