单孔三通道后腹腔镜下肾囊肿去顶减压术(附38例报告)

Single-port with three tunnels retroperitoneal laparoscopic decortication of renal cysts (a report of 38 cases)

目的探讨应用单孔三通道后腹腔镜技术建立腹膜后空间及完成肾囊肿去顶减压术的技术方法。方法 2009年4月～2009年12月,应用单孔三通道后腹腔镜技术对38例患者行肾囊肿去顶减压术。于腋后线肋缘下作3cm切口,扩张腹膜后间隙。置入自制的单孔三通道穿刺器,腹腔镜通道直径为5mm,另外2个操作通道直径分别为12和5mm。前端可弯曲的手术钳、手术剪和超声刀、吸引器配合完成肾脏游离、囊肿显露和囊壁切除。结果 38例手术均取得成功。术中出现皮下气肿1例,腹膜损伤1例。术后无继发性岀血、切口感染等并发症发生。手术时间分别为10～58min,平均28min;出血量为10～110mL,平均35mL;术后引流管留置时间4h～2d,平均24h;引流量5～150mL,平均35mL;术后住院时间1～7d,平均2.5d。随访1～8个月,无囊肿复发病例,患者腰部手术瘢痕约3cm大小。结论以胚胎性自然腔道内镜外科技术为基础,单孔腹腔镜下建立后腹腔空间及完成肾脏手术安全可行。随着技术成熟和设备改进,该技术有望为泌尿外科患者提供新的治疗选择。

【Objective】To probe the feasibility of establishing retroperitoneal working space and performing decortication of renal cysts by single-port with three tunnels retroperitoneal laparoscopic technique. 【Methods】 From April 2009 to December 2009, 38 cases of renal cysts underwent the single-port and three tunnels retroperitoneal laparoscopic decortication. A single 3 cm incision was situated in postaxillary line under the 12 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 was 5 mm, and the other two were 12 mm and 5 mm. Dissociation of kidney, exposure of cysts and excision of cyst wall were performed with ultrasound knife, suction apparatus, flexible clamp and scissor. 【Results】All procedures were technically successful. 1 case of subcutaneous emphysema and 1 case of peritoneal injury occurred in operation; No postoperative complications such as secondary blood bleeding and infection occurred. The operating time was 10 to 58 minutes, 28 minutes on average. The estimated blood loss were 10 to 150 mL, 35 mL on average. Postoperative detaining time of drainage tube was 4 hours to 2 days, 24 hours on average. Drainage capacity was 5 to 150 mL, 35 mL on average. Postoperative time in hospital was 1 to 7 days, 2.5 days on average. Time of following up were 1 to 8 months and no recurrence occurred. Only one 3 cm scar located on the lumbar. 【Conclutions】Based on E-NOTES, the feasibility of establishing retroperitoneal working space and performing renal operations by single-port with three tunnels retroperitoneal laparoscopic technique is validated. With the development of technique and equipment, it offers a new effective and prospect minimally invasive treatment for selected patients.