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后腹腔镜肾切除术治疗与肾结石病相关的无功能肾

Retroperitoneoscopic nephrectomy for non-functioning kidneys related to renal stone disease.

作者信息

Tepeler Abdulkadir, Akman Tolga, Tok Adem, Kaba Mehmet, Binbay Murat, Müslümanoğlu Ahmet Yaser, Tefekli Ahmet

机构信息

Department of Urology, Haseki Teaching and Research Hospital, 34360 [corrected] Istanbul, Turkey.

出版信息

Urol Res. 2012 Oct;40(5):559-65. doi: 10.1007/s00240-012-0466-2. Epub 2012 Feb 14.

DOI:10.1007/s00240-012-0466-2
PMID:22331348
Abstract

Laparoscopic nephrectomy has become the gold standard procedure for nonfunctioning or symptomatic benign kidneys due to renal calculi, obstructive, refluxive, and inflammatory nephropathies or renovascular hypertension. We aimed to investigate the effect of renal calculi as a reason of non-functioning on the progress and complication rates of the retroperitoneoscopic nephrectomy (RPN). During a 2-year period, 108 patients with benign renal conditions underwent RPN by single surgeon. Among these patients, total of 27 (Group 1) with a non-functioning kidney due to renal calculi were retrospectively compared with 27 patients (Group 2) with other benign renal conditions. The two groups were matched for age, body mass index, and previous renal surgery. We analyzed operative and post-operative findings and complications. The mean age and the BMI of the groups were similar. The operation time was significantly longer in Group 1 than Group 2 (p = 0.0001). There was no significant difference between the groups with respect to mean hemoglobin drop postoperatively (p = 0.9) and hospitalization time (p = 0.06). The perioperative and postoperative complication rates were higher in Group 1 but not statistically different from Group 2 (p = 0.19, p = 0.29, respectively). RPN for nonfunctioning calculous kidneys is more challenging procedure and is associated with prolonged operation time related to difficult dissection of dense adhesions. It can be safely performed by experienced hands with similar perioperative and postoperative complication rates as well as for other benign conditions of the kidney.

摘要

由于肾结石、梗阻性、反流性和炎性肾病或肾血管性高血压,腹腔镜肾切除术已成为无功能或有症状的良性肾脏的金标准手术。我们旨在研究肾结石作为无功能原因对后腹腔镜肾切除术(RPN)的进展和并发症发生率的影响。在2年期间,108例患有良性肾脏疾病的患者由单一外科医生进行了RPN手术。在这些患者中,将27例因肾结石导致肾脏无功能的患者(第1组)与27例患有其他良性肾脏疾病的患者(第2组)进行回顾性比较。两组在年龄、体重指数和既往肾脏手术方面进行了匹配。我们分析了手术和术后的发现及并发症。两组的平均年龄和BMI相似。第1组的手术时间明显长于第2组(p = 0.0001)。两组术后平均血红蛋白下降(p = 0.9)和住院时间(p = 0.06)方面无显著差异。第1组的围手术期和术后并发症发生率较高,但与第2组无统计学差异(分别为p = 0.19,p = 0.29)。对于无功能的结石性肾脏进行RPN手术更具挑战性,且与因致密粘连难以分离导致的手术时间延长有关。由经验丰富的医生操作可以安全进行,围手术期和术后并发症发生率与肾脏其他良性疾病相似。

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