Zaidi Zafar, Samad Lubna, Aquil Shahid
The Indus Hospital, C-76, Sector 31/5, Korangi Crossing, Korangi, Karachi.
J Pak Med Assoc. 2007 Jul;57(7):355-9.
To review case series of retroperitoneal laparoscopic nephrectomies.
Between May 2003 and May 2006, 60 laparoscopic nephrectomies were performed by a single surgeon. Laparoscopic route for nephrectomy was retroperitoneal in 50 cases and transperitoneal in 10 cases.
The patients included 37 males and 23 females. The mean age was 18.5 +/- 16.6 years and ranged from 2 years to 60 years. Right sided nephrectomy was performed in 31 cases while left kidney was removed in 29 cases. The indications for nephrectomy were stones (n = 29), dysplasia (n = 11), chronic pyelonephritis (n = 8), pelvi ureteric junction obstruction (n = 4), tuberculosis (n = 3), vesicoureteric reflux (n = 3) and ureterocele(n = 2). Mean operating time for laparoscopic nephrectomy alone was 140 +/- 51.1 min (range 25-300 minutes). In our series, 19 additional surgical procedures were performed under the same general anaesthesia. The mean hospital stay for all patients was 3.1 +/- 2.39 days; however the mean hospital stay for those patients who underwent laparoscopic nephrectomy without any additional procedure is 2.2 +/- 0.92 days (1.5-4 days). The mean size of kidney removed was 7.4 +/- 3.13 cm (4.6-15.9 cm). Complications were seen in 2 patients (3%); one developed wound infection and the other was found to have a haematoma for which the wound was re-explored. Conversion to open nephrectomy was required in 7 patients (11.6%) due to bleeding from renal pedicle (n = 4), poor vision secondary to pus spillage from pyonephrotic kidney (n = 2) and failure to progress due to indwelling percutaneous nephrostomy. There was no mortality and none of the patients had prolonged ileus. Blood transfusion was not required in any case. There was no bowel injury or port site herniation.
Laparoscopic nephrectomy is a feasible and safe technique. The length of hospital stay and convalescence is short and hence rapid return to normal activity is expected.
回顾腹膜后腹腔镜肾切除术的病例系列。
2003年5月至2006年5月期间，由一名外科医生实施了60例腹腔镜肾切除术。其中50例肾切除术的腹腔镜路径为腹膜后入路，10例为经腹入路。
患者包括37名男性和23名女性。平均年龄为18.5±16.6岁，范围从2岁至60岁。右侧肾切除术31例，左侧肾切除术29例。肾切除的指征包括结石（n = 29）、发育异常（n = 11）、慢性肾盂肾炎（n = 8）、肾盂输尿管连接处梗阻（n = 4）、结核（n = 3）、膀胱输尿管反流（n = 3）和输尿管囊肿（n = 2）。单纯腹腔镜肾切除术的平均手术时间为140±51.1分钟（范围25 - 300分钟）。在我们的系列中，在同一全身麻醉下还进行了19例其他外科手术。所有患者的平均住院时间为3.1±2.39天；然而，那些未进行任何其他手术的腹腔镜肾切除术患者的平均住院时间为2.2±0.92天（1.5 - 4天）。切除肾脏的平均大小为7.4±3.13厘米（4.6 - 15.9厘米）。2例患者（3%）出现并发症；1例发生伤口感染，另1例发现有血肿，为此对伤口进行了再次探查。7例患者（11.6%）因肾蒂出血（n = 4）、肾积脓肾脏脓液溢出导致视野不佳（n = 2）以及因留置经皮肾造瘘术而无法进展，需要转为开放性肾切除术。无死亡病例，且无一例患者发生肠梗阻延长。所有病例均无需输血。无肠损伤或切口疝。
腹腔镜肾切除术是一种可行且安全的技术。住院时间和康复期短，因此有望迅速恢复正常活动。
