Wang Bo, Tian Ye, Peng Yue, Ban Yong, Shan Gang, Tan Xianyu, Tang Xiaohu, Luo Guangheng, Sun Zhaolin
Department of Urology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, P.R. China.
Department of Nephrology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, P.R. China.
J Laparoendosc Adv Surg Tech A. 2020 May;30(5):520-524. doi: 10.1089/lap.2019.0746. Epub 2020 Feb 6.
To investigate the feasibility of retroperitoneal laparoscopic ipsilateral nephrectomy of a benign nonfunctional kidney after percutaneous nephrostomy, and to compare this method with open surgery. Data from 70 patients who underwent simple nephrectomy from January 2014 to October 2018 at three large centers were retrospectively analyzed. All patients underwent percutaneous nephrostomy because of renal or ureteral calculi with severe hydronephrosis or pyonephrosis. Simple nephrectomy was performed via retroperitoneal laparoscopic surgery (retroperitoneal laparoscopic group; = 33) or open surgery (open group; = 37). The retroperitoneal laparoscopic and open groups were compared regarding preoperative variables (age, sex, location of surgery, hypertension, diabetes, BMI, preoperative serum creatinine level, American Society of Anesthesiologists (ASA) grade, fistula duration, fistula size, number of fistulae, and urinary tract infection), and perioperative variables (operation time, intraoperative blood loss, postoperative drainage volume, catheter indwelling time, gastrointestinal function recovery time, duration of bedrest, duration of postoperative hospitalization, postoperative hemoglobin decline, perioperative transfusion, and postoperative complications). The retroperitoneal laparoscopic group included more patients with hydronephrosis, while the open group included more patients with pyonephrosis. There were no significant differences between the two groups in age ( = .813), sex ( = .729), location of surgery ( = .345), hypertension ( = .271), diabetes ( = .394), BMI ( = .798), preoperative serum creatinine level ( = .826), ASA grade ( = .820), fistula duration ( = .108), fistula size ( = .958), number of fistulae ( = .925), urinary tract infection ( = .111), or operative time ( = .851). The retroperitoneal laparoscopic group had significantly lesser intraoperative blood loss ( = .007), postoperative drainage volume ( = .008), shorter catheter indwelling time ( = .002), gastrointestinal function recovery time ( < .001), duration of bedrest ( < .001), and duration of postoperative hospitalization ( < .001), and lesser postoperative hemoglobin decline ( = .035) compared with the open group. Retroperitoneal laparoscopic ipsilateral nephrectomy is feasible for a benign nonfunctional kidney after percutaneous nephrostomy. The surgical method should be selected based on the surgeon's experience and the specific situation of the patient.
探讨经皮肾造瘘术后行后腹腔镜下患侧良性无功能肾切除术的可行性，并将该方法与开放手术进行比较。回顾性分析2014年1月至2018年10月在三个大型中心接受单纯肾切除术的70例患者的数据。所有患者因肾或输尿管结石伴重度肾积水或肾积脓而行经皮肾造瘘术。通过后腹腔镜手术（后腹腔镜组；n = 33）或开放手术（开放组；n = 37）进行单纯肾切除术。比较后腹腔镜组和开放组的术前变量（年龄、性别、手术部位、高血压、糖尿病、体重指数、术前血清肌酐水平、美国麻醉医师协会（ASA）分级、造瘘时间、造瘘大小、造瘘数量及尿路感染）及围手术期变量（手术时间、术中出血量、术后引流量、导管留置时间、胃肠功能恢复时间、卧床时间、术后住院时间、术后血红蛋白下降情况、围手术期输血及术后并发症）。后腹腔镜组肾积水患者较多，而开放组肾积脓患者较多。两组在年龄（P = 0.813）、性别（P = 0.729）、手术部位（P = 0.345）、高血压（P = 0.271）、糖尿病（P = 0.394）、体重指数（P = 0.798）、术前血清肌酐水平（P = 0.826）、ASA分级（P = 0.820）、造瘘时间（P = 0.108）、造瘘大小（P = 0.958）、造瘘数量（P = 0.925）、尿路感染（P = 0.111）或手术时间（P = 0.851）方面无显著差异。与开放组相比，后腹腔镜组术中出血量（P = 0.007）、术后引流量（P = 0.008）显著减少，导管留置时间（P = 0.002）、胃肠功能恢复时间（P < 0.001）、卧床时间（P < 0.001）及术后住院时间（P < 0.001）缩短，术后血红蛋白下降幅度较小（P = 0.035）。经皮肾造瘘术后行后腹腔镜下患侧良性无功能肾切除术是可行的。应根据术者经验及患者具体情况选择手术方式。
