经脐单孔多通道腹腔镜下肾切除术20例报告  

Single-port transumbilical laparoendoscopic nephrectomy.- Initial clinical experience of 20 cases

作　　者：王林辉[1] 刘冰[1] 王富博[1] 吴震杰[1] 杨庆[1] 罗文彬[1] 罗睿[1] 魏民[1] 肖亮[1] 孙颖浩[1] 

机构地区：[1]第二军医大学长海医院泌尿外科,上海200433

出　　处：《中华泌尿外科杂志》2011年第2期79-82,共4页Chinese Journal of Urology

基　　金：基金项目：上海市市级医院新兴前沿技术联合攻关项目（SHDC12010115）;上海市重点学科项目

摘　　要：目的总结经脐单孔多通道腹腔镜下。肾切除术的临床经验并评估其安全性和有效性。方法2008年12月至2010年8月对20例患者行经脐单孔多通道腹腔镜下肾切除术。其中肾癌根治术9例（左肾8例，右肾1例；均为T1期），右输尿管癌肾切除1例，无功能。肾切除10例（左侧5例，右侧5例）。取脐旁2cm切口进入腹腔，置入单孔多通道套件，5mm一体化腹腔镜下，以普通腹腔镜器械及可弯器械相配合，完成肾切除术。根治性肾切除标本取出时需适当扩大脐部切口至6cm。结果20例中，1例右输尿管癌肾切除和1例右侧无功能肾切除因出血致视野不清，中转开放手术；18例手术顺利完成（2例肾癌根治术增加5mm辅助通道），平均手术时间为197（85～510）min，平均出血量为126（50～400）ml，术中术后均未输血，术后平均住院时间6（3～14）d，术后平均留置引流管4（0～14）d。结论经脐单孔多通道腹腔镜下肾切除术安全有效，且瘢痕较小，无功能肾切除术后几乎无瘢痕，美容效果佳。其临床治疗效果尚需大样本中远期随访和对照研究进一步证实。Objective To summarize the clincical experience of transumbilical Laparoendoscopic Single-site （LESS） nephrectomy and to evaluate its safety and efficacy. Methods From December 2008 to August 2010, we have performed 20 cases of transumbilical LESS nephrectomy by Tri Port system, of which 9 patients underwent LESS radical nephrectomy （left 8, right 1, stage T1 ）, 1 pa tient underwent LESS radical resection of right ureteral carcinoma, 10 patients underwent LESS simple nephrectomy （left 5, right 5）. The Tri-Port system was inserted transperitoneally through a 2 em umbilical incision. A 5-mm 30° telescope was introduced through the port to visualize the operative field. Flexible equipment and standard laparoscopic equipment were used to perform the procedures. The incisions were extended to about 6cm in order to remove the specimens. Results Conversion to open surgery was necessary in one LESS radical resection of right ureteral carcinoma and one LESS simple nephrectomy, while the remaining 18 cases were successful （the addition of a single 5-mm port was necessary in 2 cases of LESS radical nephreetomy）. The mean operative time was 197 rain （85-- 510 min）, mean estimated blood loss was 126 ml （50--400 ml）, without blood transfusion in the peri operative period, mean postoperative hospital stay was 6.3 d （3--14 d）, and mean duration of catheter drainage was 3.6 d （0--14 d）. Conclusions Transumbilical LESS nephrectomy is feasible, safe, minimally invasive and cosmetic. Long term follow-up and a clinical control study are needed for evalu ating clinical outcomes.

关 键 词：腹腔镜 单孔 肾切除术 经脐 

分 类 号：R737.11[医药卫生—肿瘤]