单孔后腹腔镜下单纯性肾切除术的初步体会  

Retroperitoneal laparoendoscopic single-site simple nephrectomy:initial experience

作　　者：陈志[1] 陈湘[1] 罗延诚[1] 何垚[1] 李南南[1] 谢超群[1] 赖晨[1] 

机构地区：[1]中南大学湘雅医院泌尿外科,湖南长沙410008

出　　处：《中国内镜杂志》2012年第1期48-51,共4页China Journal of Endoscopy

摘　　要：目的探讨单孔后腹腔镜下单纯性肾切除术的安全性和可行性。方法 2011年3月～2011年8月,对16例无功能肾患者实施单孔后腹腔镜下单纯性肾切除术。术中在腋中线第12肋下缘作一约3cm的横行切口,自制气囊扩张后腹膜腔,置入国产单孔多通道套管,使用10mm一体式电子腹腔镜、可弯抓钳、可弯分离钳或传统腹腔镜器械完成操作。结果成功完成15例单孔后腹腔镜下单纯性肾切除手术,手术时间75～140min,平均85min,出血量20～110mL,平均56mL,术后住院时间3～5d,平均4d,术中及术后无明显并发症,术后腰部仅留一约3cm大小的手术疤痕。另外1例结核肾患者因肾周严重粘连而改为开放手术。结论单孔后腹腔镜下单纯性肾切除术难度较大,对术者技术要求较高,但在熟练掌握传统后腹腔镜肾切除技术的基础上,选择合适的病例、适应可弯器械的操作后是安全和可行的。[Objective] To evaluate the safety and feasibility of retroperitoneal laparoendoscopic single-site simple nephrectomy.[Methods] From March 2011 to August 2011,16 cases with benign nonfunctioning kidney underwent retroperitoneal laparoendoscopic single-site simple nephrectomy.A about 3cm transverse incision was made below the twelfth rib along the mid-axillary line and a homemade balloon dissector was placed into the retroperitoneal space and enlarged this space.Then homemade multichannel single-access port was inserted into the incision.The procedure was performed with the 10mm standard laparoscope,flexible grasp forceps and dissecting forceps and conventional instruments.[Results] Retroperitoneal laparoendoscopic single-site simple nephrectomy was completed in 15 cases successfully.The mean operation time was 85min（range 75 to 140）.The mean estimated blood loss was 56 mL（range 20 to 110）.The mean postoperative hospital stay was 4 days（range 3 to 5）.No major intraoperative and postoperative complication occurred.There was only about 3cm operative scar in the flank postoperatively.Conversion To open nephrectomy was performed in one patient with renal tuberculosis for severe adhesions surrounding the kidney.[Conclusion] Although retroperitoneal laparoendoscopic single-site simple nephrectomy is technically challenging and requires more laparoscopic skills,based on the extensive experience with conventional laparoscopic skill,it is feasible and safe after selecting the suitable cases and adapting the manipulation of the flexible instruments.

关 键 词：良性肾病 后腹腔途径 腹腔镜 单孔 肾切除术 

分 类 号：R617[医药卫生—外科学]