摘要目的 探讨腹腔镜下马蹄肾整形手术的方法与可行性.方法 回顾性分析2006年3月至2011年3月收治的11例马蹄肾患者的临床资料.男5例,女6例.年龄14～ 46岁,平均27岁.临床表现为左腰痛8例,左腰痛伴血尿2例,左腰痛伴发热1例.伴发肾结石6例,均为左肾结石,其中多发结石1例.伴左肾积水11例,其中中度积水6例,重度积水5例.伴右肾积水3例,均为轻度积水.伴肾功能不全2例,伴尿路感染1例.手术方法包括腹腔镜下马蹄肾峡部分离+肾盂整形术3例,峡部分离+肾盂整形+肾盂切开取石术6例,峡部分离+血管压迫松解2例. 结果 11例手术均成功.手术时间95 ～190 min,平均145 min.术中出血100 ～400 ml,平均250 ml.术后住院7～15 d,平均10 d.术后出现尿漏1例,经抗炎及局部引流后恢复；出现继发出血1例,经血管栓塞治疗后好转.术后随访6～28个月,平均17个月.6例中度积水患者5例改善至轻度,1例积水程度由术前3.5 cm缩小至3.0 cm.5例重度积水患者3例改善为中度,2例改善为轻度.1例肾盏残石患者仍有0.4 cm结石残留,3例偶有患区轻度腰酸不适,1例术后1个月出现血尿及尿路感染经抗炎治疗2周后恢复.余6例随访情况良好. 结论 经腹腔路径马蹄肾整形手术能同时处理马蹄肾峡部畸形及其并发症,可作为治疗马蹄肾疾病可选择的方法之一.

abstractsObjective To investigate the feasibility,technique and clinical effect of applying laparoscopic plastic surgery in the treatment of horseshoe kidney. Methods Eleven patients with horseshoe kidney were admitted from Mar.2006 to Mar.2011.There were 5 males and 6 females with mean age of 27years (14 to 46 years).Clinical manifestations included lower-back pain in 8 cases,lower-back pain and hematuria in 2 cases,lower-back pain and fever in 1 case.There were 6 cases accompanied with kidney calculi.All the cases with calculus were in left kidney and there was 1 case with multiple calculi.There were 11 cases accompanied with left hydronephrosis.Of which,there were moderate hydronephrosis in 6 cases,severe hydronephrosis in 5 cases.There were 3 cases accompanied with mild right hydronephrosis.There were 2 patients with renal insufficiency,1 patient with urinary tract infection.The surgery procedures included laparoscopic isthmectomy and plastic surgery in 3 cases,isthmectomy and plastic surgery and pelviolithotomy in 6 cases,isthmectomy and vascular compression release in 2 cases. Results All patients had successful surgeries with the mean operative time of 145 min (95 - 190 min).The average blood loss was 250 ml ( 100 -400 ml).Average postoperative hospital stay was 10 d (7 - 15 d).One patient suffered from urinary leakage after surgery and recovered after anti-inflammatory therapy and local drainage.One patient suffered from secondary hemorrhage controlled with DSA.All the patients were followed up with a mean of 17 months (6 -28 months).In 6 cases with moderate hydronephrosis,5 patients recovered to mild hydronephrosis and 1 case improved from preoperative renal hydronephrosis 3.5 cm to postoperative 3.0 cm.In 5 cases with severe hydronephrosis,3 patients improved to moderate hydronephrosis,2 patients to mild hydronephrosis.One patient with kidney stone had 0.4 cm residual stone.Three patients complained of occasional mild backache.One patient suffered from hematuria and urinary tract infection,recovered after antiinflammatory therapy for 2 weeks.The remaining 6 patients were in good conditions during the follow-up.Conclusion Transperitoneal laparoscopic plastic surgery is able to deal with horseshoe kidney isthmus malformation and comorbidities,and is another alternative for the treatment of horseshoe kidney.