腹腔镜辅助小切口手术在泌尿外科的临床应用

Clinical application of laparoscopy-assisted small incision surgery in treatment of urological diseases

目的尝试应用腹腔镜辅助小切口手术完成复杂的泌尿外科手术,总结临床应用体会及操作经验。方法回顾性分析我院2007年8月至2011年6月对3例孤立肾肿瘤、2例单侧多发肾肿瘤、1例双侧肾肿瘤、3例肾肿瘤合并对侧肾功能不全、3例肾盂输尿管连接部梗阻合并多发结石、1例输尿管下段肿瘤,采用腹腔镜辅助小切口手术治疗,探讨手术要点,总结临床诊治经验。结果 9例肾肿瘤患者,手术切口长4～6cm,肾冷缺血时间(15±4)min,手术耗时90～180min。所有患者引流管均于术后48h内拔出。所有患者均未出现出血、尿瘘等严重并发症,术后肾功能正常。3例肾盂输尿管连接部梗阻患者,手术切口长4～5cm,手术耗时110～190min。所有患者引流管均于术后3～5d内拔出,且均未出现出血、尿瘘等并发症。术后拔出双J管后无发热、腰痛等情况,复查静脉肾盂造影,肾盂形态良好,显影正常,无明显肾积水。1例输尿管肿瘤患者,术后3d时拔除引流管,无并发症发生。以上患者术后均未使用术后镇痛泵及镇痛药物。结论腹腔镜辅助小切口手术具有切口小、损伤轻、手术安全性高、肾功能保护好、能处理术中复杂情况等特点,尤其适用于完全腹腔镜处理有困难的病例,也是一种向标准腹腔镜复杂手术过渡的术式。

Objective To apply laparoscopy-assisted small incision surgery in complicated urological operation,and to summarize our experience.Methods We retrospectively analyzed the clinical data of 9 patients with renal tumors（3 with solitary kidney tumors,2 with unilateral multiple tumors,1 with bilateral tumors,and 3 with contralateral renal insufficiency）,3 patients with renal pelvic ureteropelvic junction obstruction（UPJO） and multiple stones,and 1 patient with distal ureteral tumor.All patients underwent laparoscopy-assisted small incision surgery in our department from Aug.2007 to Jun.2011.The key steps of the surgery were discussed and the clinical experience was summarized.Results （1） For 9 patients with renal tumors,the incision was 4-6 cm in length,the cold ischemia time was（15±4） min,and the operation time ranged from 90 to 180 min.Drainage tubes were removed within 48 h after operation.No patient had bleeding,urinary fistula or other serious complications.（2） For the 3 patients with UPJO,the incision was 4-5 cm in length and the operation time was 110 to 190 min.Drainage tubes were removed within 3-5 d after operation.No patient had bleeding,urinary fistula or other serious complications.No patient had fever or back pain after removal of double-J stents.Intravenous pyelography showed no hydronephrosis and the renal structure was normal.（3） For the patient with ureteral tumor,the drainage tube was removed 3 d after operation and there was no complication.No patients in the present study used analgesic pump or analgesic medications after surgery.Conclusion Laparoscopy-assisted small incision surgery can reduce the length of incision,minimize injury,and protect renal function.Besides,the method is safe and capable of handling complicated situations,especially suitable for patients who are difficult to receive total laparoscopic surgery.