天津医药

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经脐单孔腹腔镜应用于上尿路及肾上腺手术130例分析

陈靖   

  1. 天津医科大学第二医院泌尿外科， 天津市泌尿外科研究所
  • 收稿日期:2012-09-25 修回日期:2013-02-17 出版日期:2013-07-15 发布日期:2013-07-15
  • 通讯作者: 陈靖

Single-port transumbilical laparoscopic Surgery in Upper Urinary Tract and Adrenalectomy with report of 130 Cases

CHENJING   

  • Received:2012-09-25 Revised:2013-02-17 Published:2013-07-15 Online:2013-07-15
  • Contact: CHENJING

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摘要：

【摘要】 目的 了解自制多通道经脐单孔腹腔镜用于上尿路及肾上腺手术的技巧、疗效和安全性。 方法   130例行此手术患者， 其中肾囊肿去顶术 60例， 肾盂成形术 6例， 肾上腺切除术 2例， 输尿管切开取石术 40例， 肾部分切除术 10 例， 无功能肾切除术 12 例。 结果 130 例均在腹腔镜下顺利完成。 肾囊肿去顶术时间(25.2±4.3)min， 术中出血量(10.3±2.1)mL， 术后住院时间(2.5±0.5)d。 肾盂成形术时间 (120.9±18.6)min， 术中出血量(31.5±9.2)mL， 术后住院时间(4.0±1.0)d。 2例肾上腺手术时间分别为 50、60 min， 术中出血量分别为 50、51 mL， 术后住院时间分别为 3、4 d。 上段输尿管切开取石术时间(60.0±9.5)min， 术中出血量(32.1±9.4)mL， 术后住院时间(4.0±1.0)d。 肾部分切除术时间(134.5±15.2)min， 肾脏热缺血时间(32.5±7.5)min， 术中出血量(52.1±11.4)mL， 术后住院时间(7.0±1.0)d。 肾切除术时间(100.8±9.6)min， 出血量(125.7±25.4)mL， 术后住院时间(5.0±1.0)d。 术后随访（9.2±3.4）个月 ， 未见不良并发症。 结论 经脐单孔腹腔镜治疗上尿路及肾上腺病变安全可行， 但因其操作难度较大在临床中需谨慎推广。

关键词: 腹腔镜检查, 肾上腺切除术, 输尿管结石, 肾切除术, 肾疾病, 囊性, 肾盂成形术, 经脐单孔腹腔镜

Abstract: Objective    To summarize the surgical techniques of single-port transumbilica laparoscopic surgery in upper urinary tract and adrenalectomy by using a self made port and evaluate its feasibility and safety. Methods  From March 2010 to November 2011, 130 patients were treated with single-port transumbilical laparoscopic surgery, which included 60 cases of renal cystectomy, 6 cases of pyeloplasty, 2 cases of adrenalectomy, 40 cases of ureteral incision, 10 cases of partial nephrectomy, 12 cases of non-functioning kidney resection. The single-port was made up of two rings and a latex glove. A 2 cm incision was made in the middle of umbilicus, and the single-port was then inserted with three trocars (10,10, 5mm) inside. Tradition laparoscopic equipment and flexible laparoscopic instruments were used to perform the procedures, and the removels were taken out from the port. Results   All laparoscopic operations were successfully completed without conversion to open surgery. The addition of ports was necessary in 6 cases as a result of difficult operations and unclear vision. 60 cases of renal cystectomy: mean operative time was (25.2±4.3) min, mean blood loss was (10.3±2.1)ml, mean postoperative hospital stay was (2.5±0.5)d. 6 cases of renal pelvis：mean operative time was (120.9±18.6)min, mean blood loss was (31.5±9.2)ml, mean postoperative hospital stay was (4.0±1.0)d. 2 cases of adrenal operation: operative time was 50 and 60 min respectively, blood loss was 50 and 51 ml respectively, postoperative hospital stay was 3 and 4 d respectively. 40 cases of ureter incision to take stone: mean operative time was (60.0±9.5)min, mean blood loss was (32.1±9.4)ml, mean postoperative hospital stay was (4.0±1.0)d. 10 cases of partial nephrectomy operation: mean operative time was (134.5±15.2) min, (32.5±7.5) min of renal warm ischemia time, mean blood loss was (52.1±11.4)min, mean postoperative hospital stay was (7.0±1.0)d. 12 cases of renal resection operation: mean operative time was (100.8±9.6)min, mean blood loss was (125.7±25.4)ml, mean postoperative hospital stay was (5.0±1.0)d. Postoperative follow-up for 2-33 months, mean 18.2 months, there were no adverse complications. Conclusions    The laparoscopic single-port transumbilical surgery for upper urinary tract and adrenalectomy lesions is safe and feasible, and the cosmetic results are good, but it should be carefully widespread because of its difficulty in the clinical work.

Key words: Laparoscopy, Ureteral Calculus, nephrectomy, pyeloplasy, Laparoendoscopic single-site surgery, LESS, 经脐单孔腹腔镜