赣南医学院学报2024，Vol.44Issue(3)：230-234,5.DOI:10.3969/j.issn.1001-5779.2024.03.003
超声引导下经皮肾穿刺微造瘘在腹腔镜肾切除术治疗巨大肾积水中的应用
The application of ultrasound-guided min-percutaneous nephrostomy before laparoscopic nephrectomy for giant hydronephrosis
摘要
Abstract
Objective:To investigate the clinical application effect of ultrasound-guided min-percutaneous nephrostomy before laparoscopic nephrectomy for giant hydronephrosis.Methods:The data of 49 patients undergoing laparoscopic nephrectomy due to giant hydronephrosis were retrospectively analyzed,including 27 males and 22 females,26 cases were on the left side and 23 cases on the right side.All patients were diagnosed as giant hydronephrosis by urological ultrasonography,KUB+IVU and urological CT before surgery.They were performed ultrasound-guided min-percutaneous nephrostomy with central venous catheter before surgery.The drainage fluid was detected before operation.All 49 cases were diagnosed as non-function or pyonephrosis and underwent laparoscopic nephrectomy.The laparoscopic methods included transvaginal natural orifice transluminal endoscopic surgery nephrectomy(TVNOTES-N),suprapubic assisted laparoendoscopic single site surgery nephrectomy(SA-LESS-N)and retroperitoneal laparoscopic nephrectomy.The operation time,intraoperative blood loss,visual analogue pain score(VAS)at 24 hours after operation,ambulation time,drainage tube removal time,wound suture removal time,and postoperative hospital stay were recorded.Results:The ultrasound-guided min-percutaneous nephrostomy was successfully performed in the 49 patients.After 1 week of drainage,the median glomerular filtration rate was 9.42(7.03-18.77)mL·min-1,the median pH value of drainage fluid was 7.3(6.5-8.5),the median specific gravity of drainage fluid was 1.012(1.003-1.034),and the median renal parenteral thickness was 5(2-10)mm.No puncture related complications such as puncture channel hemorrhage,renal hemorrhage,and other collateral injuries occurred.All patients underwent nonfunctional nephrectomy successfully.No open surgery conversion,no need of additional ports occurred.The median operative time was 120(75-138)min.The median estimated blood loss was 90(60-210)mL.None of the patients received blood transfusion.There were no intraoperative complications.The median visual analogue pain score of 24 h after surgery was 2(1-3)points.The patients ambulated 1d after surgery.The drainage tube was removed on the 3 to 4 d after surgery.The wound suture removal was performed on the 7 to 8 d after surgery.The median postoperative hospital stay was 5(4-8)d.The patient recovered smoothly after operation,and the wound healed well.There was no significant change in renal function after operation.The pathological examination of all specimens was consistent with the preoperative diagnosis.All patients were followed up postoperatively,with a median follow-up of 9(8-12)months,and all patients were recovered well.Conclusion:Ultrasound-guided min-percutaneous nephrostomy before laparoscopic nephrectomy for giant hydronephrosis can not only comprehensively and objectively evaluate the affected renal function,but also decrease operative complication,reduce the difficulty of operation,and shorten the time of operation.关键词
经皮肾穿刺/腹腔镜肾切除术/巨大肾积水/超声引导Key words
Min-percutaneous nephrostomy/Laparoscopic nephrectomy/Giant hydronephrosis/Ultrasound-guided分类
医药卫生引用本文复制引用
刘林伟,邹毓华,邹晓峰,袁源湖,肖日海,伍耿青,张国玺..超声引导下经皮肾穿刺微造瘘在腹腔镜肾切除术治疗巨大肾积水中的应用[J].赣南医学院学报,2024,44(3):230-234,5.基金项目
赣州市科技局科技创新人才项目(2022CXRC9593) （2022CXRC9593）
