单孔三通道后腹腔镜肾切除术(附2例报告)

Single-port and Three Tunnels Retroperitoneal Laparoscopic Nephrectomy

目的:探讨应用单孔三通道后腹腔镜技术完成肾切除术的可行性。方法:应用单孔三通道后腹腔镜技术对2例成人无功能肾患者施行肾切除术。腋后线肋缘下作3 cm切口,扩张腹膜后间隙。置入自制的单孔三通道穿刺器,腹腔镜通道为5 mm,另外两个操作通道分别为12 mm和5 mm。手术操作通过前端可弯曲的手术钳、手术剪和超声刀、吸引器完成。结果:2例手术均取得成功。手术时间分别为156 min和174 min;出血量为100 ml和150 ml;术后住院时间均为7天。患者腰部仅留一3 cm大小的手术瘢痕。未发生术中术后并发症。结论:基于胚胎性自然腔道手术(E-NOTES)理论,我们验证了在单孔腹腔镜下建立后腹腔空间及完成肾脏手术的可行性。随着技术和设备的改进,该技术可望为患者提供有效的治疗选择。

Objective：To probe to the feasibility of performing nephrectomy by single-port and three tunnels retroperitoneal laparoseopic technique. Methods：2 cases with adult non-functioning kidney underwent the singleport and three tunnels retroperitoneal laparoscopic nephrectomy. A single 3era incision was situated in postaxillary line under the !2 rib, and retroperitoneal working space was established. The domestic trocar for single-port with three tunnels was placed in retroperitoneal space. The diameter of laparoscopic tunnel is 5mm, and the other two are 12mm and 5mm. Nephrectomy was performed with ultrasound knife , suction apparatus, flexible clamp and scissor. Results：All procedures were technically successful. The operating time was 156 and 174 minutes. The estimated blood loss was 100 and 150 mL. The length of hospital stay were all 7 days. 2 cases with only one 3cm scar on the lumbar. No intraoperative and postoperative complications occurred. Conclusions：Based on E-NOTES, the feasibility of establishing retroperitoneat working space and performing renal operations by single-port and three tunnels retroperitoneal laparoscopie technique is validated. With the development of technique and equipment, it offers a new effective and prospect minimally invasive treatment for selected patients.