CAJ | 학술논문

目的探讨后腹腔镜下肾输尿管全切除术治疗肾结核的可行性和安全性.方法 2005-2009年收治肾结核病患者28例.男18例,女10例.年龄26～51岁,平均36岁.左侧16例,右侧12例.术前经尿查抗酸杆菌、IVU、CT、B超及核素肾图等检查明确诊断为单侧无功能或重度受损肾结核,对侧肾功能正常.术前常规给予异烟肼、利福平和乙胺丁醇三联抗结核用药2周～6个月,无活动性肾外结核,红细胞沉降率正常后行后腹腔镜下肾输尿管全切除术.术中以下腔静脉和左侧输尿管为解剖标记寻找肾蒂血管,以患肾脂肪囊外平面作为游离平面.结果 28例手术均获成功,无中转开放病例.手术时间121～258 min,平均170 min;术中出血量70～250 ml,平均110 ml;术后住院5～14 d,平均5.7 d.术中损伤腹膜3例,术后切口感染2例,术后继续抗结核治疗3个月.24例随访6～20个月,平均12.5个月.患者尿路刺激症状消失,尿常规、红细胞沉降率正常,尿查抗酸杆菌阴性,B超复查对侧肾、输尿管及膀胱等未见结核病灶残留.结论后腹腔镜下肾输尿管切除术治疗肾结核安全可行,术中通过辨认解剖标记结扎肾蒂血管和沿正确的平面游离患肾是手术成功的关键.
목적 탐토후복강경하신수뇨관전절제술치료신결핵적가행성화안전성.방법 2005-2009년수치신결핵병환자28례.남18례,녀10례.년령26～51세,평균36세.좌측16례,우측12례.술전경뇨사항산간균、IVU、CT、B초급핵소신도등검사명학진단위단측무공능혹중도수손신결핵,대측신공능정상.술전상규급여이연정、리복평화을알정순삼련항결핵용약2주～6개월,무활동성신외결핵,홍세포침강솔정상후행후복강경하신수뇨관전절제술.술중이하강정맥화좌측수뇨관위해부표기심조신체혈관,이환신지방낭외평면작위유리평면.결과 28례수술균획성공,무중전개방병례.수술시간121～258 min,평균170 min;술중출혈량70～250 ml,평균110 ml;술후주원5～14 d,평균5.7 d.술중손상복막3례,술후절구감염2례,술후계속항결핵치료3개월.24례수방6～20개월,평균12.5개월.환자뇨로자격증상소실,뇨상규、홍세포침강솔정상,뇨사항산간균음성,B초복사대측신、수뇨관급방광등미견결핵병조잔류.결론 후복강경하신수뇨관절제술치료신결핵안전가행,술중통과변인해부표기결찰신체혈관화연정학적평면유리환신시수술성공적관건.
Objective To discuss the feasibility and safety of retroperitoneal laparoscopic nephrectomy for treatment of kidney tuberculosis. Methods From March 2005 to February 2009, 28 patients with kidney tuberculosis underwent retroperitoneal laparoscopic nephrectomy. The patients′ data were reviewed and analyzed. Results There were 18 men and tencwomen with an average age of 36 (26-51) in the cohort. Sixteen patients had lesions on the left kidney and 12 on right kidney. All patients had a normal renal function on the contra lateral side. The severely impaired renal function of the lesion side was confirmed before operation. Anti-tuberculosis chemotherapy was administered to patients for two weeks to six months in advance of the surgery. No active lesion of tuberculosis was found and ESR level was normal before operation. All the operations were successfully performed without switching to open surgery. The average operative time was 170 (121-258) minutes, blood loss was 110 (70-250) ml and average postoperative hospital stay was 5.7 (5-14) days. Peritoneum injury was seen in three patients and incision infection in two patients. No severe complications were observed. Anti-tuberculosis chemotherapy was continued for three months. Twenty-four patients were followed-up, and the average follow-up time was 12.5 (6-20) months. All patients recovered without any lesion remaining. Conclusions Retroperitoneal laparoscopic nephrectomy could be a safe and reliable method for the treatment of non-functioning kidney due to tuberculosis.