经阴道纯NOTES肾囊肿去顶术1例报告并文献复习

Pure Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Unroofing of Renal Cyst:Report of One Case and Review of the Literatures

目的:报告1例经阴道纯自然腔道内镜手术(NOTES)肾囊肿去顶术的临床经验和体会。方法:采用经阴道纯NOTES肾囊肿去顶术治疗右肾囊肿患者1例。患者取截石位,患侧垫高约30°,头低脚高约25°。剪开阴道后穹窿黏膜约3 cm,在5 mm无损伤分离钳的引导下置入5 mm Trocar,插入5 mm 0°。远端可弯曲(四方向)腹腔镜,证实无肠管损伤。扩大阴道后穹窿切口至3 cm,置入Triport。改头高脚低约25°,患侧抬高约60°。游离右肾囊肿,切除外露囊壁并取出,彻底止血后留置盆腔引流管,关闭切口。结果:手术顺利完成。手术时间75 min,术中失血量约为20 ml。患者手术后第1天拔除尿管和盆腔引流管并下床活动,笫2天肛门通气并进饮食。术后第4天出院。结论:经阴道纯NOTES肾囊肿去顶术临床应用可行,其美容优势明显。该手术的成功实施,为经阴道纯NOTES其它术式的探索提供了借鉴。

Objective：To describe the initial clinical experience of pure transvaginal NOTES for unroofing of renal cyst,and evaluate its feasibility. Methods： In December 2010,one 61 year-old female patient with right renal cyst, underwent pure transvaginal NOTES. After induction of general anesthesia, the patients was positioned in lithotomy with right lumbar at 30°angle to the operating table. The patients was in a Trendelenburg＇s position. A 3 mm incision was made at the posterior vaginal fornix, and a 5 mm Trocar was introduced into the pelvic cavity guided by a 5 mm forceps. A 5 mm 0° flexible laparoscope was inserted into the pelvic cavity to confirm no rectum injury. Then a Triport was introduced at the posterior vaginal fornix. The patients head end was uppered by 25° with right lumbar at 60°angle to the horizontal plane. The right renal cyst was found after wrapped tissues dissection. Part of renal cyst wall was cut by an ultraeision harmonic scalpel and removed. Drainage tube was placed in the pelvic cavity through vagina. The vaginal incision was closed under direct vision using a 2/0 absorbable suture. Results：The procedure was successfully finished. The operative time was 75 rain. The estimated blood loss was 20 ml. There was no intraoperative or postoperative complications. The pelvic drainage was removed on postoperative day 1 and the patient resumed ambulation. The patient resumed nutrition 2 days after surgery,and discharged on postoperative day 4. Conclusions： Pure transvaginal NOTES for unroofing of renal cyst is feasible. This novel technique seeks to provide cosmetic and minimally invasive result. This procedure could also provide experience for ex- ploration for other transvaginal pure NOTES.