耻骨上辅助单孔腹腔镜肾切除术(附90例报告)  

Suprapubic-assisted laparoendoscopic single-site surgery nephrectomy with report of 90 cases

作　　者：张国玺[1,2] 伍耿青[1,2] 邹晓峰[1,2] 袁源湖[1,2] 肖日海[1,2] 王晓宁[1,2] 薛义军[1,2] 龙大治[1,2] 吴玉婷[1,2] 刘佛林[1,2] 刘全亮[1,2] 刘敏[1,2] 徐辉[1,2] 廖云峰[1,2] 钟辛[1,2] 徐刚[1,2] 谢昆林 

机构地区：[1]赣南医学院第一附属医院泌尿外科 [2]赣南医学院泌尿外科研究所,江西赣州341000

出　　处：《微创泌尿外科杂志》2013年第6期-,共4页Journal of Minimally Invasive Urology

基　　金：国家高技术研发计划(863计划)项目(2012AA021100);江西省"赣鄱英才555工程"领军人才培养计划项目;江西省科技厅重大科技支撑计划项目(20121BBG70032);江西省教育厅科技落地计划项目(KJLD12044);江西省卫生厅科技计划项目;赣南医学院重大科技计划项目(ZD2009003)

摘　　要：目的:评价耻骨上辅助单孔腹腔镜肾切除术(suprapubic-assisted laparoendoscopic single-site surgery nephrectomy,SA-LESS-N)的安全性、可行性和有效性.方法:共收治90例患者,男72例,女18例,年龄20～78岁,平均51.7岁.包括肾积水致无功能肾69例,肾癌19例,肾结核2例.手术在全麻下进行,患者取健侧70°卧位,脐缘置入两个Trocar及操作器械,自耻骨联合患侧阴毛覆盖处置入一Trocar及腹腔镜.手术方法同标准腹腔镜手术.切除标本装袋,延长耻骨上切口或粉碎后取出.结果:除5例患者术中中转标准腹腔镜手术和1例中转开放手术外,其余手术均顺利完成.平均手术时间:单纯性肾切除术110(95～175)min,根治性肾切除术90(75～160)min.平均失血量155(55～ 300) ml.平均术后住院时间7.2(5～ 8)d.术后疼痛轻,切口愈合良好,手术瘢痕隐蔽,美容效果佳.结论:SA-LESS-N安全、可行、有效,术后患者疼痛轻、美容效果佳,值得临床应用.Objective:To describe the initial clinical experience of suprapubic-assisted laparoendoscopic single-site surgery nephrectomy(SA-LESS-N)in Urology,and evaluate its safety,feasibility and efficacy.Methods:Ninety consecutive patients including 72males and 18females,with a mean age of 51.7years(range 20to 78),were subjected to SA-LESS-N in our center.There were 69non-functioning kidneys,19renal carcinomas,and 2tuberculosis kidneys in our study.Under general anesthesia,the patients were positioned in lateral decubitus with affected side elevated 70°.One 5-and 10-mm(or two 5-mm)trocars were inserted into the umbilical edge.A 10-or 5-mm trocar was inserted into abdominal cavity below the pubic hairline,through which a 10-mm 30°or 5-mm 0°laparoscope was placed.The operation was same as that of standard laparoscopy.The specimens were removed after the incisions below the pubic hairline were enlarged or they were crashed.Results:SA-LESS-N was successfully completed in 84patients.Five patients required conversion to standard laparoscopy because of intraoperative bleeding(n=4),and failure to progress(n=1).One patient underwent open conversion because of gradual bleeding during the dissection of dense adhesive renal pedicle due to infection and fibrosis.The mean operative time for simple nephrectomy 110(range from 95to 175)mins,radical nephrectomy 90(range from 75to 160)mins.The mean blood loss was 155(range from 55to 300)ml.Hospitalization duration was between 5and 8days with a mean postoperative stay of 7.2days.The mean follow-up of 16.2(range from 2to 35)months showed hidden umbilicus scar.The suprapubic scar was not detectable because of the pubic hairs.Conclusions:SA-LESS-N appears to be feasible,safe and effective.It would not only lead to improved cosmetic results,but lead to little postoperative pain.

关 键 词：单孔腹腔镜术 经脐途径 耻骨联合 肾切除术 

分 类 号：R692[医药卫生—泌尿科学]