同时进行的双侧腹腔镜肾盂切开术:三例患者的病例系列

IF 0.4 4区 医学 Q4 SURGERY Indian Journal of Surgery Pub Date : 2024-06-29 DOI:10.1007/s12262-024-04106-w
Rudramani, Sunil Kumar Singh, Anamika Chandra, Vikas Singh
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引用次数: 0

摘要

一些患者患有双侧肾结石和输尿管结石,伴有或不伴有肾积水,但肾功能保留。双侧腹腔镜肾盂切开取石术(SBLP)迄今为止尚未开展,患者都是同步进行手术。在此,我们报告了 3 例成人和儿童患者的经腹腔镜 SBLP 手术。一名 30 岁的男性患者左肾反复出现大的肾盂结石,右肾则有小结石;一名 40 岁的男性患者左侧单发肾盂结石,伴有小的下肾盏结石,另一侧肾盂和输尿管上部的钙化支架部分断裂。一名 8 岁男孩患有双侧单发肾盂结石。所有 3 名受试者都保留了肾盏、轻度肾积水、中等大小的肾盂外和肾功能。手术在全身麻醉下进行。在插入 DJ 支架后,使用 3-0 号聚乙二醇内酯缝合线进行了细致的肾盂切开缝合。所有受试者的盆腔内均放置了单根腹腔引流管 FG 20。三名患者中有两名成功取出了两侧的所有结石。第三位患者(40 岁,男性)左肾遗留多个小结石(5 毫米),使用输尿管镜取出了钙化的断裂支架部分。这些病例的手术时间平均为 2 小时 25 分钟。失血量极少,平均不到 50 毫升。这三例病例为我院其他科室更多开展双侧腹腔镜肾盂结石同时输尿管结石切除术铺平了道路,增强了信心。肾盂内的腹腔镜肾结石切除术可能更加困难,目前正在尝试单侧结石切除术。肾盂外结石可首先尝试 SBLP。只有在一侧结石及时成功切除后,才能进行第二侧结石切除术。
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Simultaneous Bilateral Laparoscopic Pyelolithotomy: a Case Series of Three Patients

Several patients present with bilateral renal and ureteric stones with or without hydronephrosis and preserved renal functions. Simultaneous bilateral laparoscopic pyelolithotomy (SBLP) is hitherto, not performed and patients are operated metachronously. Here, we report 3 cases of transperitoneal SBLP in adult and paediatric patients. A 30-year-old gentleman had a recurrent large pelvic stone in the left kidney and a small one in the right; a 40-year-old man had left solitary pelvic calculus with small lower calyceal calculus and broken calcified stent parts in the renal pelvis and upper ureter on the other side. An 8-year-old boy had bilateral solitary renal pelvic stone. All 3 subjects had preserved calyces, mild hydronephrosis, moderate size extra-renal pelvis and preserved renal functions. SBLP under general anaesthesia was performed. Meticulous pyelotomy closure was done using Polygalactin suture 3–0 with intra-corporeal suturing after DJ stent insertion. Single abdominal drain FG 20 was placed in the pelvis in all subjects. Two out of three patients underwent successful removal of all stones on both sides. In the third patient (40-year man), multiple small calculi (< 5 mm) in the left kidney were left behind and the part of calcified broken stent was removed using a ureteroscope. The operative time was 2 h and 25 min on an average in these cases. The blood loss was minimal on an average less than 50 ml. The 3 illustrative cases have paved the path and the confidence to undertake simultaneous bilateral laparoscopic pyelolithotomy and uretero-lithotomy more frequently in other units at our institute. Laparoscopic nephrolithotomy in intra-renal pelvis may be more difficult and is being attempted in single side stones. To start with SBLP may be tried in extra-renal pelvic stones. Second side should only be proceeded on after timely and successful completion on one side.

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来源期刊
CiteScore
0.60
自引率
25.00%
发文量
412
审稿时长
6-12 weeks
期刊介绍: The Indian Journal of Surgery is the official publication of the Association of Surgeons of India that considers for publication articles in all fields of surgery. Issues are published bimonthly in the months of February, April, June, August, October and December. The journal publishes Original article, Point of technique, Review article, Case report, Letter to editor, Teachers and surgeons from the past - A short (up to 500 words) bio sketch of a revered teacher or surgeon whom you hold in esteem and Images in surgery, surgical pathology, and surgical radiology. A trusted resource for peer-reviewed coverage of all types of surgery Provides a forum for surgeons in India and abroad to exchange ideas and advance the art of surgery The official publication of the Association of Surgeons of India 92% of authors who answered a survey reported that they would definitely publish or probably publish in the journal again The Indian Journal of Surgery offers peer-reviewed coverage of all types of surgery. The Journal publishes Original articles, Points of technique, Review articles, Case reports, Letters, Images and brief biographies of influential teachers and surgeons. The Journal spans General Surgery, Pediatric Surgery, Neurosurgery, Plastic Surgery, Cardiothoracic Surgery, Vascular Surgery, Rural Surgery, Orthopedic Surgery, Urology, Surgical Oncology, Radiology, Anaesthesia, Trauma Services, Minimal Access Surgery, Endocrine Surgery, GI Surgery, ENT, Colorectal Surgery, surgical practice and research. The Journal provides a forum for surgeons from India and abroad to exchange ideas, to propagate the advancement of science and the art of surgery and to promote friendship among surgeons in India and abroad. This has been a trusted platform for surgons in communicating up-to-date scientific informeation to the community.
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