Fornara P, Doehn C, Miglietti G, Fricke L, Steinhoff J, Sack K, Jocham D
Department of Urology, Medical University of Lübeck, Germany.
Nephrol Dial Transplant. 1998 May;13(5):1221-5. doi: 10.1093/ndt/13.5.1221.
Laparoscopy is believed to result in possible clinical benefits for the patient. We report our experience with renal laparoscopy in dialysis patients and compare the results with those from non-dialysis patients.
Between December 1994 and April 1997, 19 dialysis patients underwent laparoscopic nephrectomy or nephroureterectomy at our hospital. The group consisted of 11 female and eight male patients (mean age 45 years). In nine patients the indication for nephrectomy was chronic pyelonephritis. Nephroureterectomy for vesicoureteral reflux with recurrent episodes of pyelonephritis or analgesic nephropathy for exclusion of transitional cell carcinoma of the upper urinary tract was considered in nine other patients. Laparoscopic bilateral nephrectomy for drug-resistant hypertension was performed in one patient. In comparison, a consecutive group of non-dialysis patients who had undergone renal laparoscopy was reviewed.
In the dialysis group, one patient had to be converted to open nephrectomy due to bleeding. Six dialysis patients required blood transfusions compared with none in the non-dialysis group. There were four complications in the dialysis group and two in the non-dialysis group. Both groups had comparable results for operative times, analgesic consumption, postoperative start of oral intake and mobilization, and duration of hospitalization and convalescence.
Laparoscopic nephrectomy in dialysis patients has acceptable results. The higher transfusion rate is probably due to a lower preoperative haemoglobin and is not aggravated by possible affects of the clotting system in patients with chronic uraemia.
腹腔镜检查被认为可能给患者带来临床益处。我们报告我们在透析患者中进行肾腹腔镜检查的经验，并将结果与非透析患者的结果进行比较。
1994年12月至1997年4月期间，我院19例透析患者接受了腹腔镜肾切除术或肾输尿管切除术。该组包括11名女性和8名男性患者（平均年龄45岁）。9例患者肾切除术的指征为慢性肾盂肾炎。另外9例患者因膀胱输尿管反流伴复发性肾盂肾炎或镇痛剂肾病以排除上尿路移行细胞癌而接受肾输尿管切除术。1例患者因耐药性高血压接受腹腔镜双侧肾切除术。作为对照，我们回顾了一组连续接受肾腹腔镜检查的非透析患者。
在透析组中，1例患者因出血不得不转为开放性肾切除术。6例透析患者需要输血，而非透析组无一例输血。透析组有4例并发症，非透析组有2例并发症。两组在手术时间、镇痛药用量、术后开始经口进食和活动的时间以及住院和康复时间方面结果相当。
透析患者的腹腔镜肾切除术结果可以接受。输血率较高可能是由于术前血红蛋白水平较低，而非慢性尿毒症患者凝血系统的可能影响所致。
