单曲卡单孔腹腔镜手术在泌尿外科的应用  

Single trocar laparoscopic surgery： a report of 45 cases

作　　者：薛波新[1] 单玉喜[1] 阳东荣[1] 孙传洋[1] 高洁[1] 崔勇[1] 陶伟[1] 朱进[1] 

机构地区：[1]苏州大学附属第二医院泌尿外科,215004

出　　处：《中华医学杂志》2011年第36期2552-2554,共3页National Medical Journal of China

摘　　要：目的初步总结单曲卡单孔腹腔镜手术在泌尿外科应用的体会。方法2010年4—12月，施行单曲卡下的单孔腹腔镜手术45例。分别为腹腔镜下精索静脉高位结扎术17例，后腹腔镜下肾囊肿去顶减压术24例、输尿管切开取石术4例。腹腔镜手术组，在脐孔做15mm切口，建立CO2气腹，穿刺入10mm曲卡，置人整合工作通道的单通道腹腔镜，经上述工作通道放入操作器械，完成精索静脉高位结扎术。后腹腔镜手术组，在患侧髂嵴上3指做15mm切口，IUPU法（Institute of urology，Peking Universily的首字母缩写）建立后腹腔，同样方法穿刺人10mm曲卡，置入整合工作通道的单通道腹腔镜，经工作通道放入操作器械，完成肾囊肿去顶减压术、输尿管切开取石术。结果两组45例患者，完成41例单曲卡下的腹腔镜手术，2例肾囊肿及2例输尿管结石，再增加一枚5mm曲卡后完成手术。手术时间：腹腔镜组23～70min；后腹腔镜组45—175min。术中出血少，术后住院1～5d。两组术后均无明显并发症。结论对于一些比较简单的腹腔镜手术，完全可以施行一种全新的、更微创的单曲卡单孔腹腔镜手术来完成。Objective To report the initial urological applications of single trocar laparoscopic surgery. Methods From April to December 2010, a total of 45 urologic patients underwent single trocar laparoscopic surgery. The procedures included high ligations of spermatics vessels （n = 17）, unroofing of renal cysts （ n = 24） and ureterolithotomy （ n = 4）. Transperitoneal approach ： A 15 mm incision was made in umbilicus and CO2 pneumoperitoneum created. A 10-mm trocar was inserted into enterocoelia. After the installation of single punch laparoscope （STROZ） , the operating instruments were guided through integrated working channel to complete operative procedures. Retroperitoneal approach： A 15 mm incision was made above the diseased-side crista iliaca for around 4 cm. Retroperitoneal cavity was prepared for retroperitoneoscopy with the IUPU （Institute of Urology, Peking University） technique. In the same way, a 10-mm trocar was inserted. And the single punch laparoscope was installed to complete operative procedures. Results The procedures were successful in 41 cases. But the others （renal cysts, n = 2; ureteral calculus, n --2 ） were successfully managed by adding a 5 mm trocar. Operation time： transperitoneal approach, 23 - 70 min; retroperitoneal approach, 45 - 175 rain. The intra-operative volume of blood loss was minimal. And the hospital stay was 1 -5 days. No significant postoperative complication occurred. Conclusion For some relatively simple procedures, a new and more minimally invasive approach of single trocar lauarosconic surgery may be attempted.

关 键 词：腹腔镜 单孔腹腔镜 泌尿外科手术 

分 类 号：R699[医药卫生—泌尿科学]