RESUMEN
Objective To discuss the clinical features and treatment of ureteral obstruction resulted from vena genitalis compression.Methods 2 cases of hydronephrosis resulted from vena genitalis compression were discussed retrospectively,and relevant literatures were reviewed.Both of the 2 patients presenting with mild loin pain,and imaging studies showed hydronephrosis.One patients presenting with left hydronephrosis,and the other showed bilateral hydronephrosis.Imaging study showed ureter obstruction at L3-L4 level.Laparoscopic surgery found vena genitalis crossing and compressing the upper part of the ureter,resulted the upper ureter and pelvis dilation.Laparoscopic excision of vena genitalis were performed on these two cases.Results These patients'symptoms were relieved and hydronephrosis alleviated evidently 3 month after surgery in follow-up.Conclusions Hydronephrosis resulted from vena genitalis compression is a rare clinical manifestation.Classical imaging presents with ureter obstruction at L3-L5 level,at which the vena genitalis crossing the musculi psoas major.Ureter migrates outwards and the upper ureter and pelvis dilate.Pre-operative diagnosis is difficulty,but laparoscopic resection of the vena genitalis to relieve the obstruction of the ureter is recommended.
RESUMEN
Objective To discuss the operating skills of transperitoneal laparoscopic radical nephrectomy(LRN).Methods From Dec 2008 to Dec 2010,105 patients with renal tumors were treated by transperitoneal LRN.Fifty-one tumors were located in left kidney,and 54 in the right kidney.The mean diameter of renal tumor was(5.8 ± 2.4)cm.There were 48 cases of T1N0M0,51 of T2N0M0,6 of T3aN0M0.During the process of transperitoneal LRN,vena genitalis was constantly used as an operative mark for seeking and ligating the renal artery and vein.The specimens were cut completely and removed through Pfannensteil incision.Results All the 105 cases were performed by transperitoneal LRN with vena genitalis marking method successfully.Twenty-eight cases of homolateral adrenal gland were resected and 16 cases of regional lymph node were cleaned.There was no serious injury of liver,spleen or bowels.The operating time ranged 44-78 min with an average of 55 min,and the blood loss was 35-600 ml with the mean of 85 ml.The post-operative length of stay was 4-11 d with an average of 6 d.Major complications included 3 cases of vessel injury,1 case with an injury of diaphragmatic muscle and 2 cases with a lymphous leakage.Post-operative staging included 44 cases of T1 N0 M0,1 of T1 N1 M0,47 of T2 N0 M0,1 of T2 N1 M0,7of T3aN0M0,1 of T3aN1 M0,2 of T4N0M0,and 2 cases with benign lesion.The patients were followed up for 9-33 months with an average of 18 months.One case had an incisional hernia,1 had a local tumor recurrence and 1 died of pulmonary metastasis.Conclusions Transperitoneal LRN with vena genitalis marking method could be safe for the treatment of renal tumors.The vena genitalis may act as a mark for the accurate location and quick ligation for the renal pedicle without serious injuries,and such patients could recover fastly with fewer complications.Pfannensteil incision has a good quality of little trauma and could meet with the need of aesthetics.