Clinical Outcomes Analysis Of Curative Effect Of Retroperitoneal Laparoscopic Nephroureterectomy With Bladder-cuff Resection Of Tuberculous Kidneys

Objective：To Investigate the clinical outcomes of retroperitoneal laparoscopic nephroureterectomy with bladder-cuff resection of nonfunctioning tuberculous kidneys.Methods: A retrospective analysis of58patients,27man and31women, mean age (57.68.3)years of kidney tuberculosis. According to the preoperative examination, afterselecting30patients underwent laparoscopic surgery,12patients the needle electrode was used to circleround incise the bladder thoroughly0.5cm away from the ureterostoma,dissected the joint of opening of the ureter and bladder. Three trocars in the waist were used for dissecting the kidney,and the ureter was dissected as far distally downward.We could use the pliers to pull out the down ureter,enlarged the cuff cut,then took out the renal and the the whole ureter,so we could aviod the abdomen cut. If it is lower ureter adhesion heavier, then an incision of (6.51.5)cm was created in the lower abdomen to allow dissected of the distal ureter and intact specimen extraction.18patients after laparoscopic nephrectomy, ureter tryto cut to the lesion，28patients underwent open nephrectomy.Results:58cases of successful surgery.Laparoscopic surgery group,3patients due to renal weeks, severe adhesions around the ureter, toopen surgery.The mean operative time was （114.612.3） minutes. The mean hemorrhage was （48.58.4）ml, no case of conversionto open surgery. The recovery time of gastrointestinal function aftersurgery was （18.55.4）.The mean time drainage and Foley catheter were （4.60.8）days, and （8.41.6）days, all the patientswere given the type-B ultrasonic to evaluate the leakage of urine around the bladder. The total time of postoperative hospitalization was（8.52.4）d.Open nephrectomy group, the mean operative timewas （94.68.4） minutes,.The mean hemorrhage was （53.86.4）ml. The recovery time of gastrointestinal function after surgery was （23.84.7）h. The mean time drainage was （6.81.3）d, The total time of postoperative hospitalization was（11.32.4）d. Postoperative disease kidney specimens cut visible caseous necrosis foci and cavitation, some specimens showed calcification, pathological examination were consistent with the diagnosis of renal tuberculosis.Anti-tuberculosis chemotherapy was continued for three months．58patients were followed-up，and the average follow up time was （8.31.9）months．All patients recovered without any lesion remaining．Conclusion: Retroperitoneal laparoscopic nephroureterectomy withbladder-cuff resection of nonfunctioning tuberculous kidneys safe，effective, easy and less invasive treatment operation, The needleelectrode was used to circleround incise the bladder dissected the joint of opening of the ureter and bladder.,which can completely exc ise the ureter.Patients with renal tuberculosis can avoid line openabdominal incision ureteral resection, effectively reducing trauma, effective and reliable. For most patients with renal tuberculosis, RenalWeek, adhesions around the ureter is not heavy patients the operation mode can be alternative to open operation.