Abedinzadeh Mehdi, Nouralizadeh Akbar, Radfar Mohammad Hadi, Moslemi Mohammad Kazem
Department of Urology, Moradi Hospital, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
Ger Med Sci. 2012;10:Doc05. doi: 10.3205/000156. Epub 2012 Feb 9.
The standard treatment for a duplex kidney with poorly functioning upper pole moiety is ipsilateral upper pole heminephrectomy. This procedure is usually performed by open surgery, but with recent developments in techniques of uro-laparoscopy, it can be done with it, safely. In this study we evaluated the results and safety of laparoscopic heminephrectomy in our consecutive cases.
From February 2001 to May 2007 fourteen unilateral laparoscopic heminephrectomy were performed in our center. Patients' characteristics, presenting symptoms, operative time, and blood loss, early and late complications were all collected retrospectively. Using pre-operative ultrasonography, intravenous pyelography (IVP) and CT scanning, unilateral upper pole hydronephrosis was detected in all cases. By DMSA isotope scan hypofunctioning of ipsilateral moieties was detected in all cases.
Mean operative time was 203±80 minutes. No major intra-operative or early complications were identified. Mean hospital stay was 4.1 days. On mean follow-up of 32 months no disturbing symptoms or episodes of urinary tract infections (UTIs) were detected. Atrophic kidney was detected in one case in post-operative IVP.
Laparoscopic heminephrectomy is a valuable minimal invasive procedure that can be performed safely in experienced hands without any important complication. Perfect renal pedicles vascular system manipulation is important for the preservation of renal function post-operatively.
对于上极部分功能不佳的重复肾，标准治疗方法是同侧上极半肾切除术。该手术通常通过开放手术进行，但随着泌尿外科腹腔镜技术的最新发展，也可以安全地通过腹腔镜完成。在本研究中，我们评估了连续病例中腹腔镜半肾切除术的结果和安全性。
2001年2月至2007年5月，我们中心共进行了14例单侧腹腔镜半肾切除术。回顾性收集患者的特征、症状、手术时间、失血量、早期和晚期并发症。所有病例术前均通过超声、静脉肾盂造影（IVP）和CT扫描检测到单侧上极肾积水。通过二巯基丁二酸（DMSA）同位素扫描，所有病例均检测到同侧部分功能减退。
平均手术时间为203±80分钟。未发现术中或早期重大并发症。平均住院时间为4.1天。平均随访32个月，未发现令人困扰的症状或尿路感染（UTI）发作。术后IVP检查发现1例肾萎缩。
腹腔镜半肾切除术是一种有价值的微创手术，在经验丰富的医生手中可以安全进行，且无任何重大并发症。完美地处理肾蒂血管系统对于术后肾功能的保留很重要。
