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首页> 外文期刊>BJU international >The role of retroperitoneoscopy in the management of renal and adrenal pathology.
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The role of retroperitoneoscopy in the management of renal and adrenal pathology.

机译：腹膜后镜检查在肾和肾上腺病理学管理中的作用。

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OBJECTIVES: To describe the technique, findings and results of retroperitoneoscopic ablation of recalcitrant renal, giant adrenal and complex peripelvic cysts, and nephrectomy for nonfunctioning congenital anomalous kidneys. PATIENTS AND METHODS: Nine patients (six men and three women, mean age 56 years, range 44-68, five with renal, two with adrenal and two with peripelvic cysts, diameter 6-14 cm) were treated by retroperitoneoscopic cyst ablation using three 10-mm ports. Six further patients (two male and four female, mean age 24 years, range 13-38) underwent retroperitoneoscopic nephrectomy using three or four ports for anomalous nonfunctioning kidneys; three patients had a pelvic kidney, two a horseshoe kidney and one an iliac kidney. Isthmusectomy was also performed in the patients with horseshoe kidneys. RESULTS: Retroperitoneoscopic cyst ablation was successful in all nine patients; the mean (range) operative duration was 69 (50-85) min in patients with simple renal and adrenal cysts, and 185 (160-210) min in patients with peripelvic cysts. The mean (range) blood loss was 130 (50-200) mL and hospital stay 2.33 (2-4) days. At the last follow-up, 15-39 months after the procedure, all patients were asymptomatic and satisfied with the outcome, with no recurrence of cysts. Retroperitoneoscopic nephrectomy with isthmusectomy (when applicable) was successful in the six patients with anomalous kidneys, with a mean (range) operative duration of 105 (85-120) min; the mean (range) blood loss was 116 (75-150) mL and the analgesic requirement 208 (150-250) mg of diclofenac sodium. The hospital stay was 2-3 days and the delay before return to preoperative activity 7-14 days. CONCLUSIONS: Retroperitoneoscopic cyst ablation is a safe and effective method to treat symptomatic cysts of the upper urinary tract which are refractory to other forms of management. Dissection is difficult in patients with peripelvic cysts. Retroperitoneoscopic nephrectomy for anomalous kidneys is a challenging procedure because of the abnormal location, anomalous vessels and presence of an isthmus. With advances in laparoscopy and increasing experience, open surgery for such conditions is likely to become obsolete.
机译：目的：描述难治性先天性异常肾脏的顽固性肾，巨大肾上腺和复杂的盆腔囊肿的腹腔镜后消融技术，发现和结果，以及肾切除术。患者与方法：9例患者（6名男性和3名女性，平均年龄56岁，范围44-68，五名肾脏，两名肾上腺和两名骨盆周囊肿，直径6-14厘米）接受了腹腔镜后囊肿消融术，其中三例10毫米端口。另有6名患者（2名男性和4名女性，平均年龄24岁，范围13-38）接受腹腔镜后肾切除术，使用三个或四个端口治疗异常肾功能不全; 3例患者有盆腔肾，2例为马蹄肾，1例为肾。马蹄肾患者也进行了峡部切除术。结果：所有9例患者腹腔镜后囊肿消融均成功。单纯性肾和肾上腺囊肿的平均手术时间为69（50-85）min，而骨盆周囊肿的平均手术时间为185（160-210）min。平均失血量为130（50-200）mL，住院天数为2.33（2-4）天。在手术后15-39个月的最后一次随访中，所有患者均无症状，对结局满意，囊肿未复发。腹腔镜肾切除加峡部切除术（适用时）在6例肾脏异常的患者中获得了成功，平均手术时间为105（85-120）分钟。平均（范围）失血量为116（75-150）mL，止痛需要量为208（150-250）mg双氯芬酸钠。住院时间为2-3天，而恢复术前活动的延迟时间为7-14天。结论：腹膜后镜囊肿消融术是治疗上尿路症状性囊肿的一种安全有效的方法。盆腔囊肿患者很难进行解剖。由于腹腔异常位置，血管异常和峡部的存在，腹腔镜肾切除术对异常肾脏是一项具有挑战性的手术。随着腹腔镜检查技术的进步和越来越多的经验，针对这种情况的开放式手术可能已经过时。

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