Nephrectomy indications in kidney diseases: 10-years’ experience study

Safaa Gatea, Mezban, M. F. Albadran, S. G. Mezban, E. B. Alfadli, K. H. Jareh
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Abstract

Background. Nephrectomy, a performance surgery in urology practice, may lead to an irreversibly kidney injuries during surgical removal. This study aims to describe 10-years of experience with nephrectomy, its indications and complications in kidney diseases. Materials and methods. Data for all the patients who underwent nephrectomy were collected including demographics, age, sex, education, smoking, alcohol consumption, aetiology, past medical and surgical history and comorbidity. Indications for nephrectomy were stones, obstruction, tumors, pyelonephritis and autosomal dominant polycystic kidney disease. Among complications, thrombocytopenia, fever, hyperkalemia, hypertension, ileus, pneumonia, pneumothorax, septic shock, surgical site infection, hyperglycemia, bleeding and postoperative nausea and vomiting were recorded. Preoperative preparation included laboratory tests such as complete blood count, renal function test and liver function test. It is reasonable to perform renoscintography before nephrectomy to consider partial nephrectomy. However, in our study we performed it routinely because nearly all patients underwent ultrasonography or/and computed tomography scan of abdomen/pelvis to detect pathologies. A percutaneous polyurethane catheters or stents were placed. A guidewire was inserted into the kidney via the rigid cystoscope. Results. A total of 50 nephrectomies were performed. The median age of patients was 45 years ranging from 14 to 73 years. About 60 % of the patients were females and 40 % were males. Patients were educated (48 %), smoking (56 %), alcoholic (12 %), with past medical and surgical history (50 %), comorbidities (46 %) and lived in rural region (44 %) and urban areas (56 %). Stones and obstruction accounted for the majority of cases, 52 and 36 %, respectively. Most of the nephrectomies were performed with laparoscopic approach (58 %). Open surgery was done in 15 cases (30 %) because of adhesions and emphysema. Complications related to laparoscopy and open surgery occurred in 17 (34 %) of patients. Thrombocytopenia, fever, hyperkalemia, hypertension, ileus, pneumonia, pneumothorax, septic shock, surgical site infection, hyperglycemia, bleeding and postoperative nausea and vomiting were recorded. Conclusions. Stone disease and obstruction were the most common benign conditions requiring nephrectomy. The laparoscopic approach can be feasible for most benign kidney diseases requiring nephrectomies with adequate expertise. Сomplication rate in it is comparable with that of open surgery.
肾脏疾病的肾切除术适应症:10 年经验研究
背景。肾切除术是泌尿外科的一种常见手术,在手术切除过程中可能会对肾脏造成不可逆转的损伤。本研究旨在描述 10 年来肾脏切除术的经验、适应症以及肾脏疾病的并发症。材料和方法。收集了所有接受肾切除术患者的数据,包括人口统计学、年龄、性别、教育程度、吸烟、饮酒、病因、既往病史、手术史和合并症。肾切除术的适应症包括结石、梗阻、肿瘤、肾盂肾炎和常染色体显性多囊肾。并发症包括血小板减少、发热、高钾血症、高血压、回肠炎、肺炎、气胸、脓毒性休克、手术部位感染、高血糖、出血和术后恶心呕吐。术前准备包括实验室检查,如全血计数、肾功能检查和肝功能检查。肾切除术前进行肾镜检查以考虑肾部分切除术是合理的。然而,在我们的研究中,由于几乎所有患者都接受了腹部/骨盆超声波或/和计算机断层扫描以检测病变,因此我们常规进行了肾镜检查。经皮置入聚氨酯导管或支架。通过硬质膀胱镜将导丝插入肾脏。结果共进行了 50 例肾切除术。患者的中位年龄为 45 岁,从 14 岁到 73 岁不等。约 60% 的患者为女性,40% 为男性。患者受过教育(48%),吸烟(56%),酗酒(12%),有内外科病史(50%),有合并症(46%),居住在农村(44%)和城市(56%)。结石和梗阻占大多数,分别为 52% 和 36%。大部分肾切除术采用腹腔镜方法(58%)。15例(30%)因粘连和气肿而进行了开腹手术。17例(34%)患者出现了与腹腔镜手术和开腹手术相关的并发症。这些并发症包括血小板减少、发热、高钾血症、高血压、回肠炎、肺炎、气胸、脓毒性休克、手术部位感染、高血糖、出血以及术后恶心和呕吐。结论结石病和梗阻是需要进行肾切除术的最常见良性疾病。只要有足够的专业知识,腹腔镜方法对大多数需要进行肾切除术的良性肾脏疾病都是可行的。腹腔镜手术的并发症发生率与开腹手术相当。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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