经脐单孔多通道腹腔镜下肾切除三例  

Single-port transumbilical laparoscopical nephrectomy： initial clinical experience of 3 cases

作　　者：孙颖浩[1] 王林辉[1] 杨波[1] 许传亮[1] 侯建国[1] 肖亮[1] 刘冰[1] 

机构地区：[1]第二军医大学附属长海医院泌尿外科,上海200433

出　　处：《中华外科杂志》2009年第22期1709-1711,共3页Chinese Journal of Surgery

摘　　要：目的探讨经脐单孔多通道腹腔镜肾切除术的安全性和可行性。方法2008年12月至2009年8月期间，对3例无功能肾患者施行经脐单孔多通道腹腔镜下肾切除术。患者均为男性，年龄分别为26岁、34岁和65岁。其中2例为先天性肾盂输尿管狭窄伴重度。肾积水（左右各1例），1例为输尿管上段狭窄伴重度肾积水（左侧）。3例患者患。肾在静脉。肾盂造影中均不显影，且GFR〈0．90ml／s。全身麻醉后取健侧卧位，沿脐缘切开皮肤2cm，置人Tripo~单孔系统。使用可弯抓钳、剪刀和传统腹腔镜器械完成操作。使用血管直线切割器直接离断肾蒂。标本装袋后由切口直接取出。结果顺利完成2例手术，时间分别为85min和165rain，出血分别为50m1和100ml，未增加另外工作通道，术后住院天数为3d和5d。另外1例因肾蒂周围粘连严重而改开放手术。前2例术后3周进行随访，切口瘢痕隐藏在脐内，患者恢复良好。结论经脐单孔多通道腹腔镜下肾切除术难度较大，在选择合适的病例、适应可弯器械的交叉操作模式后仍是安全和可行的。术后无明显手术瘢痕，有着较好的临床应用前景。Objective To evaluate the safety and efficacy of single-port transumbilical laparoscopical nephrectomy. Methods From December 2008 to August 2009, we have performed three cases of single-port transumbilical laparoseopical nephrectomy of nonfunctioning renal by Tri-Port system. Among three patients there were two cases of UPJO and one case of upper ureteral obstruction. Involved kidneys were not visualized in IVU and the GFR were not more than 0. 90 mL/s. Tri-Port system was inserted transperitoneally through a 2 cm umbilical incision. The flexible grasper, scissors were used in addition to standard laparoscopic equipment. Renal pediele was divided by Endoscopic Linear Stapling device. Specimens were extracted through the incision. Results The first and second case were successful, and the operation time were 85 rain and 165 rain. The bleeding volume were 50 ml and 100 ml. The discharge time after operation was 3 days and 5 days, respectively. The third case was converted to open surgery because of the edema and adhesion of renal pedicle. At 3 weeks of follow-up, the incisions were hidden in the umbilicus with good cosmetic benefit. Conclusions This new method is technically feasible, which combined with these advantages of less trauma and more cosmetic benefit. However, more special instruments and long learning curving may be needed for those surgeons, who are going to carry out it.

关 键 词：腹腔镜检查 肾切除术 

分 类 号：R686[医药卫生—骨科学]