经脐可拉伸切口腹腔镜术式在大肾癌切除术中的应用体会  

Laparoscopic radical nephrectomy of large renal carcinoma with single incision triangulated umbilicus surgery

作　　者：祝广峰[1] 窦小亮[1] 郑小龙[1] 高小平[1] 曹清[1] 王禾[1] 汪涌[1] ZHU Guang-feng DOU Xiao-liang ZHENG Xiao-long GAO Xiao-ping CAO Qing WANG He WANG Yong(Department of Urology, Tangdu Hospital, the Fourth Military Medical University, Xi＇an 710038, China)

机构地区：[1]第四军医大学唐都医院泌尿外科,陕西西安710038

出　　处：《现代泌尿外科杂志》2017年第6期433-436,共4页Journal of Modern Urology

摘　　要：目的探讨经脐可拉伸切口多通道腹腔镜手术(又名单切口三角经脐手术,SITUS)在大体积肾癌(直径>7cm)切除中的手术体会。方法 2015年8月至2016年9月,对7例大体积肾癌患者(3例右肾,4例左肾)实施SITUS肾切除术,总结分析其临床资料。结果 7例患者均顺利完成手术。手术时间(125.3±32.5)min,出血量(167±45.7)mL。术中、术后均未输血,术后拔除引流管时间为(2.5±1.6)d,术后住院时间(4.7±3.1)d,2例体重指数大于28(kg/m^2)的患者的右肾切除术中增加1个5mm辅助通道。术后伤口隐藏于脐周,美容效果良好。结论 SITUS手术方式进行大体积肾癌根治性手术可行,手术安全,取出标本无须延长切口,术后瘢痕可隐藏于脐周围,临床开展不需要特殊器械,手术难度较普通腹腔镜有一定程度增加,但可克服。Objective To summarize the experience of removing large renal carcinoma（diameter7 cm）with single-incision triangulated umbilical surgery（SITUS）.Methods Clinical date of 7 cases of large renal carcinoma treated with laparoscopic SITUS during Aug.2015 and Sept.2016 were retrospectively analyzed.Results All operations were successful,without conversion to open surgery or traditional laparoscopic surgery.The mean operation time was（125.3±32.5）min.The mean blood loss was（167±45.7）mL.No blood transfusion was required during or after the operation.Drainage tube was removed（2.5±1.6）days after operation,and the average hospital stay was（4.7±3.1）days.For the 2 patients with body mass index（BMI）28,an accessory channel was established.After operation,the wound was concealed in the umbilicus and showed satisfactory cosmetic results.Conclusions Laparoscopic SITUS is feasible and safe for large renal carcinoma.As the scars can be hidden in the umbilicus,the cosmetic effect is satisfactory.SITUS can be performed without special instruments.Although it is more difficult than traditional laparoscopic procedure,the difficulties are conquerable.

关 键 词：经脐 可拉伸切口腹腔镜手术 根治性肾切除术 大体积肾癌 

分 类 号：R699.2[医药卫生—泌尿科学]