Chen R N, Moore R G, Micali S, Kavoussi L R
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Urology. 1997 Aug;50(2):195-8. doi: 10.1016/S0090-4295(97)00188-X.
Retroperitoneoscopic renal biopsy can be technically challenging in extremely obese patients because of loss of surgical landmarks and difficulty in identifying the kidney within retroperitoneal adipose tissue. We present our experience with retroperitoneoscopic renal biopsy in extremely obese patients and describe our surgical technique.
We performed retroperitoneoscopic renal biopsies on 8 extremely obese patients (body mass index greater than 40). Mean patient weight was 144.3 kg. Three patients presented with acute renal failure and 5 presented with nephrotic range proteinuria. Retroperitoneoscopic renal biopsy was indicated based on extreme obesity alone in 3 patients, 2 patients had failed previous attempts at percutaneous biopsy, 1 patient had a solitary kidney, 1 patient required chronic anticoagulation, and 1 patient was a Jehovah's Witness. Intraoperative ultrasonography and an anatomic approach facilitated the dissection and identification of the kidney.
All eight retroperitoneoscopic renal biopsies were completed successfully without complication and all patients were discharged within 24 hours of the procedure. Sufficient tissue for pathologic diagnosis was obtained in all cases. Mean operating room time was 153 minutes and mean estimated blood loss was 71 mL. The patients returned to normal activity at a mean of 1.8 weeks.
With the use of intraoperative ultrasonography and a systematic, anatomic approach, retroperitoneoscopic renal biopsy can be successfully completed in extremely obese patients. This procedure can be reliably performed on an outpatient basis with minimal morbidity and should be considered a viable alternative to open renal biopsy.
由于手术标志的丧失以及在腹膜后脂肪组织中识别肾脏困难，腹膜后腹腔镜肾活检术对于极度肥胖患者在技术上具有挑战性。我们介绍了我们在极度肥胖患者中进行腹膜后腹腔镜肾活检的经验，并描述了我们的手术技术。
我们对8例极度肥胖患者（体重指数大于40）进行了腹膜后腹腔镜肾活检。患者平均体重为144.3千克。3例患者表现为急性肾衰竭，5例表现为肾病范围蛋白尿。仅因极度肥胖而行腹膜后腹腔镜肾活检的有3例，2例患者此前经皮活检失败，1例患者为孤立肾，1例患者需要长期抗凝，1例患者是耶和华见证会成员。术中超声检查和解剖学入路有助于肾脏的分离和识别。
所有8例腹膜后腹腔镜肾活检均成功完成，无并发症发生，所有患者均在术后24小时内出院。所有病例均获得了足够用于病理诊断的组织。平均手术时间为153分钟，平均估计失血量为71毫升。患者平均在1.8周后恢复正常活动。
通过术中超声检查以及系统的解剖学入路，腹膜后腹腔镜肾活检术可在极度肥胖患者中成功完成。该手术可在门诊可靠地进行，发病率极低，应被视为开放性肾活检的可行替代方法。
