Hemal A K, Gupta N P, Kumar R
Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
J Urol. 2000 Jul;164(1):32-5.
We describe, define and evaluate the role of retroperitoneoscopic nephrectomy for tuberculous nonfunctioning kidneys, and compare the results with those of open nephrectomy in similar cases in a nonrandomized study.
Beginning in July 1994, 9 patients underwent retroperitoneoscopic nephrectomy for tuberculous nonfunctioning kidneys at our center. Data obtained from the records of these patients were compared with those of 9 who underwent open nephrectomy for a similar indication during the same period. Retroperitoneoscopic nephrectomy was initially performed by kidney dissection followed by ligation of the hilar vessels. The technique was subsequently modified and the vessels controlled before dissecting the kidney. Various parameters were compared and statistical analysis was done.
The 2 groups were similar in regard to patient age, gender and side of disease. Retroperitoneoscopic nephrectomy was successful in 7 of the 9 patients. Although 2 of our initial patients required conversion to open surgery, the remaining 7 successfully underwent retroperitoneoscopic nephrectomy after modifying the technique. Mean operative time was slightly greater in the retroperitoneoscopy than in the open surgery group (103.3 versus 92.2 minutes). Mean blood loss was less in the retroperitoneoscopy group (101.4 versus 123.3 ml.), mean hospital stay plus or minus standard deviation was significantly shorter (3.2 +/- 0.83 versus 8.88 +/- 3.37 days) and mean time to return to work was significantly less (3 versus 7 weeks). Mean analgesic requirement for opioids and diclofenac sodium was also lower in the retroperitoneoscopic nephrectomy group (0 versus 1.44 +/- 0.72 and 3.8 +/- 1.3 versus 4.3 +/- 1.2 doses, respectively). Minor complications developed in only 2 retroperitoneoscopy cases.
Tuberculosis has been considered a contraindication to retroperitoneoscopic nephrectomy due to a high conversion rate. However, we believe that our modified technique of retroperitoneoscopic nephrectomy is a viable option for managing tuberculous nonfunctioning kidneys. The conversion rate is lower than previously reported. Comparing our results with those of open nephrectomy shows that retroperitoneoscopic nephrectomy is beneficial in all respects except for slightly longer operative time. Because of the benefits of minimally invasive surgery, this approach should be considered in such cases.
我们描述、定义并评估后腹腔镜肾切除术在结核性无功能肾治疗中的作用，并在一项非随机研究中，将其结果与类似病例的开放肾切除术结果进行比较。
自1994年7月起，我们中心有9例患者接受了后腹腔镜结核性无功能肾切除术。将这些患者记录中获得的数据与同期因类似指征接受开放肾切除术的9例患者的数据进行比较。后腹腔镜肾切除术最初是先进行肾脏游离，然后结扎肾门血管。随后对该技术进行了改进，在游离肾脏之前先控制血管。比较了各项参数并进行了统计分析。
两组在患者年龄、性别和患侧方面相似。9例患者中有7例后腹腔镜肾切除术成功。虽然最初的2例患者需要转为开放手术，但在改进技术后，其余7例成功接受了后腹腔镜肾切除术。后腹腔镜组的平均手术时间略长于开放手术组（103.3分钟对92.2分钟）。后腹腔镜组的平均失血量较少（101.4毫升对123.3毫升），平均住院时间加减标准差显著缩短（3.2±0.83天对8.88±3.37天），平均恢复工作时间显著缩短（3周对7周）。后腹腔镜肾切除术组对阿片类药物和双氯芬酸钠的平均镇痛需求也较低（分别为0对1.44±0.72以及3.8±1.3对4.3±1.2剂）。仅2例后腹腔镜手术病例出现轻微并发症。
由于高转化率，结核病一直被视为后腹腔镜肾切除术的禁忌证。然而，我们认为我们改进的后腹腔镜肾切除术技术是治疗结核性无功能肾的可行选择。转化率低于先前报道。将我们的结果与开放肾切除术的结果进行比较表明，除手术时间略长外，后腹腔镜肾切除术在各方面都有益处。由于微创手术的优势，在这类病例中应考虑采用这种方法。
