Gimenez L F, Micali S, Chen R N, Moore R G, Kavoussi L R, Scheel P J
Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Kidney Int. 1998 Aug;54(2):525-9. doi: 10.1046/j.1523-1755.1998.00006.x.
Renal biopsy continues to be a pivotal tool and frequently indispensable diagnostic procedure in the clinical assessment of proteinuria and or unexplained renal disease. Laparoscopic renal biopsy has recently been reported as an alternative to open renal biopsy.
Thirty-two patients who had proteinuria and/or renal insufficiency underwent laparoscopic renal biopsy at our center. The indications for biopsy included failed percutaneous biopsy (N = 3), morbid obesity (14), solitary kidney (5), chronic anticoagulation/coagulopathy (6), religious consideration (refusal of potential blood transfusion) (2), multiple bilateral renal cysts and body habitus (1 case each). The kidney was approached via a laparoscopic retroperitoneal route (retroperitoneoscopy) using a two port technique. The lower pole of the kidney was localized using blunt dissection, laparoscopic cup biopsies were performed, and hemostasis was achieved using standard techniques.
All biopsies were successfully completed laparoscopically with sufficient tissue obtained for histopathological diagnosis in all cases. Mean estimated blood loss was 25.9 ml (range 5 to 100). None of the patients required parenteral narcotics during the perioperative period. Operative time ranged from 0.8 to 3.0 hours (mean 1.5). Mean hospital stay was 1.7 days (range 0 to 7). Sixteen patients were treated as outpatients. Patients returned to normal activity at a mean of 1.7 weeks (range 0.3 to 3.0) postoperatively. In one patient, the spleen was inadvertently biopsied without consequence. An additional patient developed a postoperative 300 cc perinephric hematoma that resolved without the need for intervention. One postoperative mortality occurred on postoperative day seven secondary to a perforated peptic ulcer in a patient undergoing high-dose steroid therapy for lupus nephritis.
Laparoscopic renal biopsy is a safe, reliable, minimally invasive alternative to open renal biopsy for patients in whom a closed percutaneous approach is either a relative or absolute contraindication, which can be performed on an outpatient basis.
肾活检仍然是蛋白尿和/或不明原因肾病临床评估中的关键工具和常用的不可或缺的诊断程序。最近有报道称腹腔镜肾活检可作为开放性肾活检的替代方法。
32例患有蛋白尿和/或肾功能不全的患者在我们中心接受了腹腔镜肾活检。活检的适应证包括经皮活检失败（n = 3）、病态肥胖（14例）、孤立肾（5例）、慢性抗凝/凝血障碍（6例）、宗教因素（拒绝潜在输血）（2例）、多发双侧肾囊肿和体型因素（各1例）。采用双端口技术经腹腔镜后腹膜途径（后腹腔镜）对肾脏进行操作。通过钝性分离确定肾下极，进行腹腔镜杯状活检，并采用标准技术实现止血。
所有活检均通过腹腔镜成功完成，所有病例均获得足够的组织用于组织病理学诊断。估计平均失血量为25.9毫升（范围为5至100毫升）。围手术期没有患者需要胃肠外麻醉。手术时间为0.8至3.0小时（平均1.5小时）。平均住院时间为1.7天（范围为0至7天）。16例患者作为门诊患者接受治疗。患者术后平均1.7周（范围为0.3至3.0周）恢复正常活动。1例患者无意中对脾脏进行了活检，但未产生后果。另1例患者术后出现300毫升肾周血肿，无需干预即可自行吸收。1例患者术后第7天因狼疮性肾炎接受大剂量类固醇治疗并发消化性溃疡穿孔死亡。
对于经皮闭合活检为相对或绝对禁忌证的患者，腹腔镜肾活检是一种安全、可靠、微创的开放性肾活检替代方法，且可在门诊进行。
