Dönmez Muhammet Irfan, Yazici Mustafa Sertaç, Abat Deniz, Kara Önder, Bayazit Yildirim, Bilen Cenk Yücel
Department of Urology, School of Medicine, Hacettepe University, Sihhiye/Ankara, Turkey.
Department of Urology, School of Medicine, Çukurova University, Balcali/Adana, Turkey.
Urol J. 2015 Apr 29;12(2):2074-7.
To present our results of laparoscopic upper pole heminephrectomy in adult patients with duplex kidney.
A total of 10 patients with an age range of 27 to 54 years old underwent laparoscopic upper pole heminephrectomy for complete duplication of the renal collecting system. The key point of the technique included the placement of a catheter in the normal ureter at the beginning of the procedure. The patient was positioned in a 45-90 degrees lateral decubitus position and a 4-port transperitoneal or 3-port retroperitoneal technique was applied followed by the mobilization of the upper pole ureter away from the renal hilum. Afterwards, the vasculature supplying the upper pole was precisely identified and ligated. Followed by transection of the ureter and its transposition cephalad to the hilum, the upper pole moiety was fully transected using the harmonic scalpel.
Eight patients were operated on using the transperitoneal approach and 2 using the retroperitoneal technique. One patient required preoperative percutaneous drainage due to pyonephrosis. The operation time ranged between 150 to 350 min with minimal blood loss (0-200 mL). Hemostasis was achieved with an Argon laser in one patient. The lower pole calyceal system was perforated in one patient and repaired intracorporally. No major intraoperative complications occurred. All of the patients except two had their drains removed in 72 h after the operation and were generally discharged on postoperative day 3.
Laparoscopic upper pole heminephrectomy for an ectopic ureter is safe and reproducible and offers benefits of laparoscopic surgery even in patients with complicated urinary tract infection.
介绍我们对成年重复肾患者行腹腔镜上极半肾切除术的结果。
共有10例年龄在27至54岁之间的患者因肾集合系统完全重复而接受了腹腔镜上极半肾切除术。该技术的关键要点包括在手术开始时将导管置入正常输尿管。患者取45 - 90度侧卧位，采用四孔经腹腔或三孔后腹腔技术，随后将上极输尿管从肾门游离。之后，精确识别并结扎供应上极的血管。接着切断输尿管并将其向上移位至肾门，使用超声刀将上极部分完全切断。
8例患者采用经腹腔入路手术，2例采用后腹腔技术。1例患者因肾盂积脓术前需要经皮引流。手术时间为150至350分钟，出血量极少（0 - 200毫升）。1例患者使用氩激光止血。1例患者下极肾盏系统穿孔并在体内修复。未发生重大术中并发症。除2例患者外，所有患者术后72小时拔除引流管，一般于术后第3天出院。
腹腔镜上极半肾切除术治疗异位输尿管是安全且可重复的，即使对于合并复杂尿路感染的患者也具有腹腔镜手术的优势。
