经脐单孔腹腔镜在肾癌根治术中的应用

Efficacy and safety of transumbilical single-port laparoscopic radical nephrectomy

目的:评价经脐单孔腹腔镜肾癌根治性切除术的安全性与初步疗效。方法:回顾性分析北京大学第三医院泌尿外科2010年6月至2010年10月行腹腔镜肾癌根治术的临床资料,其中经脐单孔腹腔镜肾癌根治性切除术10例,经后腹腔镜肾癌根治术15例。比较两组在一般情况、肿瘤大小、肿瘤部位、手术时间、出血量、住院时间等指标的差异。经脐单孔途径应用自制单孔装置,切除标本置入取物袋,在脐部切口取出;经后腹腔途径应用传统三套管操作,标本置入取物袋,经腰部扩大切口取出。结果:两组间比较显示经脐单孔途径与经后腹腔途径在手术时间、术后视觉模拟疼痛评分(visual analog pain scale,VAPS)差异有统计学意义,其他指标差异无统计学意义。所有患者术中、术后无血肿、感染、肠梗阻、切口疝等并发症。术后随访6～10个月,肿瘤无复发。结论:经脐单孔腹腔镜肾癌根治术安全、有效,切口隐蔽,适于年轻或对切口美观要求高的患者。

Objective： To evaluate the efficacy and safety of transumbilical single-port laparoscopic ra-dical nephrectomy.Methods： The clinical data of laparoscopic radical nephrectomy performed from June 2010 to October 2010 in Peking University Third Hospital were analyzed retrospectively.In the study,10 patients underwent transumbilical single-port laparoscopic radical nephrectomy（LESS） and 15 received retroperitoneal laparoscopic radical nephrectomy.The data on general presentation,tumor size,tumor location,operative time,blood loss,complications,Visual Analog Pain Scale（VAPS）,postoperative hospital stay,pathological results were collected to compare between the two groups.Our homemade single-site equipment was used in the LESS approach and the kidney was dissociated after being cut off the renal vessel and extracted through the umbilical incision.The retroperitoneal approach followed the standard surgical procedures,and the specimens were removed from the extended incision.Results： All the procedures were completed without conversion to open radical nephrectomy.Compared with traditional laparoscopic surgery,the operative time（P=0.001） and VAPS（P=0.002） showed significant difference in LESS group,and no difference was noted in other factors（P〈0.05）.There was no secondary blee-ding,wound infection,intestinal obstruction,incision hernia and other severe postoperative complications.The follow-up of 6 to 10 months showed no local recurrence.Conclusion： Transumbilical single-port laparoscopic radical nephrectomy is feasible,effective and safe.It gives a more mini-invasive and cosmetic option for young or female patients.