经阴道纯NOTES肾切除术2例报告并文献复习  

Pure Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Nephrectomy:Report of two Cases and Review of the Literatures

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

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：《临床泌尿外科杂志》2011年第9期641-644,共4页Journal of Clinical Urology

基　　金：江西省卫生厅科技计划项目(NO.20111074);江西省卫生厅重大科技计划项目(NO.20104008)

摘　　要：目的:评价经阴道纯自然腔道内镜手术(NOTES)肾切除术的临床可行性和有效性。方法:对1例右肾无功能和1例左肾结石并左肾萎缩、左肾无功能的女性患者行经阴道纯NOTES肾切除术。患者取全麻,截石位。切开阴道后穹窿,置入Triport及操作器械。所有操作均经此Triport完成,按照普通腹腔镜肾切除方法游离并切除患肾,装入自制标本袋,自阴道后穹窿切口取出。留置盆腔引流管,缝合阴道后穹窿切口。结果:手术均顺利完成,术中未出现肠管、实质性器官和大血管损伤等并发症。手术时间分别为330 min、300 min,术中失血量分别为300 ml、250 ml。例1、2分别于术后第2、1天下床活动,第3、2天肛门通气并进饮食。2例均于术后第6天痊愈出院,患者体表均无切口或穿刺孔。结论:经阴道纯NOTES肾切除术临床应用可行,美容优势明显,可在临床选用。但仍需进一步研发、完善相关器械。Objective：To describe the initial clinical experience of pure transvaginal natural orifice transluminal endoscopic surgery（NOTES） for nephrectomy, and evaluate its feasibility and efficacy. Methods： A 55-year-old female patient with nonfunctional right kidney, and a 44-year-old female patient with nonfunctional left kidney, underwent pure transvaginal NOTES nephrectomy. After induction of general anesthesia, the patients were positioned in lithotomy. A Triport was introduced at the posterior vaginal fornix. The patients head end was elevated by 25° with right lumbar at 60° angle to the floor. The ipsilateral kidney was dissected, and renal artery and vein were clipped with Hem-O-lock clips according to the method of a standard laparoscopic nephrectomy. The specimen was placed inside a homemade bag and removed under direct vision through an extended incision at posterior vaginal fornix, after the kidney was completely excised. The pelvic cavity was drained by one tube brought out through vagina. The vaginal wound was closed under direct vision using a 2/0 absorbable suture. Results：Both procedures were successfully finished. The operative time was 330 and 300 min, respectively. The estimated blood loss was 300 and 250 ml, respectively. There was no intraoperative or postoperative complication. The patients resumed ambulation on postoperation day 2 and 1, respectively. The patients resumed oral diet on postoperative day 3 and 2, respectively. Both patients were discharged on postoperative day 6. Conclusions： Pure transvaginal NOTES for nephrectomy is feasible and effective. This novel technique seeks to provide cosmetic result even when compared to today＇s minimally invasive procedures. However, special instruments need developing.

关 键 词：肾切除术 肾脏疾病 经自然腔道内镜手术 经阴道途径 

分 类 号：R699.2[医药卫生—泌尿科学] R692[医药卫生—外科学]