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目的:探讨后腹腔镜脂肪囊外切除结核肾的应用价值。方法:回顾性分析2008年1月～2011年6月46例肾结核患者行后腹腔镜下结核肾脂肪囊外切除术的临床资料:男19例,女27例,中位年龄34(20～64)岁。打开侧锥筋膜和Gerota筋膜后,背侧紧贴腰大肌在脂肪囊外游离,腹侧在脂肪囊和Gerota筋膜之间游离。用Hem-o-lok(41例)或Endocutter(3例)处理肾蒂,把肾放入肾袋后取出。结果:除早期2例因肾门处渗血视野不清中转开放外,44例均成功完成脂肪囊外肾切除。手术时间为118(80～186)min,术中失血量45.4(10～350)ml,术后住院时间为6.5(5～8)天。无腹膜损伤和脓肾破裂,围手术期无并发症,切口均一期愈合。46例随访1～43个月,平均19个月,对侧肾功能正常。结论:后腹腔镜脂肪囊外方法行结核肾切除术便于游离、创伤小、出血少、恢复快,对于结核肾是一种比较安全、可靠的手术方法。
Objective: To investigate the value of retroperitoneoscopic fat capsule excision of tuberculosis kidney. Methods: A retrospective analysis of 46 patients with renal tuberculosis underwent laparoscopic renal nephroureterectomy from January 2008 to June 2011 were retrospectively analyzed. Among them, 19 were males and 27 were females, with a median age of 34 (range 20 ~ 64) years old. After opening the trapezius fascia and Gerota fascia, the dorsal ploys closest to the psoas is free outside the fat capsule and the ventral side free between the fat capsule and the Gerota fascia. Kidney pedicles were treated with Hem-o-lok (41 cases) or Endocutter (3 cases) and the kidneys were placed in kidney bags and removed. Results: In addition to the early two cases due to renal hilar vision is not clear transit to open, the 44 cases were successfully completed outside the fat capsule nephrectomy. The operation time was 118 (80-186) min. The intraoperative blood loss was 45.4 (10-350) ml. The postoperative hospital stay was 6.5 (5-8) days. No peritoneal injury and purulent renal rupture, no complications during perioperative period, all incisions healed. 46 cases were followed up for 1 ~ 43 months, an average of 19 months, contralateral renal function was normal. Conclusions: The retroperitoneoscopic laparoscopic fat extracapsular nephrectomy is convenient and free from traumatic nephrectomy with less trauma, less bleeding and rapid recovery. It is a safe and reliable surgical method for tuberculous kidney.