Hemal A K, Aron M, Gupta N P, Seth A, Wadhwa S N
Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
BJU Int. 1999 Jun;83(9):929-36. doi: 10.1046/j.1464-410x.1999.00086.x.
To describe the technique, findings and results of retroperitoneoscopic ablation of recalcitrant renal, giant adrenal and complex peripelvic cysts, and nephrectomy for nonfunctioning congenital anomalous kidneys.
Nine patients (six men and three women, mean age 56 years, range 44-68, five with renal, two with adrenal and two with peripelvic cysts, diameter 6-14 cm) were treated by retroperitoneoscopic cyst ablation using three 10-mm ports. Six further patients (two male and four female, mean age 24 years, range 13-38) underwent retroperitoneoscopic nephrectomy using three or four ports for anomalous nonfunctioning kidneys; three patients had a pelvic kidney, two a horseshoe kidney and one an iliac kidney. Isthmusectomy was also performed in the patients with horseshoe kidneys.
Retroperitoneoscopic cyst ablation was successful in all nine patients; the mean (range) operative duration was 69 (50-85) min in patients with simple renal and adrenal cysts, and 185 (160-210) min in patients with peripelvic cysts. The mean (range) blood loss was 130 (50-200) mL and hospital stay 2.33 (2-4) days. At the last follow-up, 15-39 months after the procedure, all patients were asymptomatic and satisfied with the outcome, with no recurrence of cysts. Retroperitoneoscopic nephrectomy with isthmusectomy (when applicable) was successful in the six patients with anomalous kidneys, with a mean (range) operative duration of 105 (85-120) min; the mean (range) blood loss was 116 (75-150) mL and the analgesic requirement 208 (150-250) mg of diclofenac sodium. The hospital stay was 2-3 days and the delay before return to preoperative activity 7-14 days.
Retroperitoneoscopic cyst ablation is a safe and effective method to treat symptomatic cysts of the upper urinary tract which are refractory to other forms of management. Dissection is difficult in patients with peripelvic cysts. Retroperitoneoscopic nephrectomy for anomalous kidneys is a challenging procedure because of the abnormal location, anomalous vessels and presence of an isthmus. With advances in laparoscopy and increasing experience, open surgery for such conditions is likely to become obsolete.
描述经后腹腔镜切除顽固性肾囊肿、巨大肾上腺囊肿和复杂肾盂旁囊肿以及对无功能先天性异常肾脏进行肾切除术的技术、发现和结果。
9例患者（6例男性，3例女性，平均年龄56岁，范围44 - 68岁，5例为肾囊肿，2例为肾上腺囊肿，2例为肾盂旁囊肿，直径6 - 14 cm）采用三个10毫米端口经后腹腔镜囊肿切除术治疗。另外6例患者（2例男性，4例女性，平均年龄24岁，范围13 - 38岁）采用三个或四个端口经后腹腔镜对异常无功能肾脏进行肾切除术；3例为盆腔肾，2例为马蹄肾，1例为髂肾。马蹄肾患者还进行了峡部切除术。
9例患者经后腹腔镜囊肿切除术均成功；单纯肾囊肿和肾上腺囊肿患者的平均（范围）手术时间为69（50 - 85）分钟，肾盂旁囊肿患者为185（160 - 210）分钟。平均（范围）失血量为130（50 - 200）毫升，住院时间为2.33（2 - 4）天。在最后一次随访时，即手术后15 - 39个月，所有患者均无症状且对结果满意，囊肿无复发。6例异常肾脏患者经后腹腔镜肾切除术（如适用则进行峡部切除术）成功，平均（范围）手术时间为105（85 - 120）分钟；平均（范围）失血量为116（75 - 150）毫升，镇痛需要208（150 - 250）毫克双氯芬酸钠。住院时间为2 - 3天，恢复术前活动前的延迟时间为7 - 14天。
经后腹腔镜囊肿切除术是治疗对其他治疗方式难治的上尿路有症状囊肿的一种安全有效的方法。肾盂旁囊肿患者的解剖操作困难。由于位置异常、血管异常和峡部的存在，经后腹腔镜对异常肾脏进行肾切除术是一项具有挑战性的手术。随着腹腔镜技术的进步和经验的增加，针对此类病症的开放手术可能会过时。
