单通道无气腹后腹腔镜肾癌根治性切除术临床应用体会

The Clinical Application Experience of Laparoscopic Radical Nephrectomy via Single-site without Pneumoperitoneum in 126 Cases

目的探讨一种微创的肾癌根治手术方法。方法对126例T1期肾癌患者采用单通道无气腹后腹腔镜肾癌根治性切除术,左侧76例,右侧50例。取患侧12肋尖部斜向前下4~6 cm手术切口,经切口置入腹腔镜,直视或监视器下进行操作,利用特制瓶颈状深部拉钩向内侧牵拉,建立后腹腔空间,利用特制长止血钳和深部打结器分离、结扎、切断肾动静脉、输尿管,分离切除肾、肾周筋膜、脂肪、区域淋巴组织。结果单通道无气腹后腹腔镜肾癌根治性切除术手术时间45～120 min,术中出血20～80mL。术后2 d离床活动,术后3～4 d拔出引流管,术后7～8 d痊愈出院。结论单通道无气腹后腹腔镜肾癌根治性切除术是一种微创的治疗肾癌的手术方法。

Objective To explore the clinical application of minimally invasive laparoscopic radical nephrectomy via single-site without pneumoperitoneum.Methods 126 cases of T1 renal cancer were treated with laparoscopic radical nephrectomy via single-site without pneumoperitoneum in our hospital,including 76 cases of left,50 cases of right.4 to 6 cm incision from the inferior edge of tip of the 12th rib was taken.Through the incision,we put into laparoscopy and manipulated under direct vision or monitor,bottlenecks-like deep special retractors was used to maintain the exposure,special long clamps and long deep knotter were used for separation and ligation of the renal vein,renal artery,ureter.The kidney,perirenal fascia,fat,regional lymph nodes were then dissected and fully resected.Results The procedure was successfully carried out in all cases and the operation time was 45 to 120 minutes;there was no need for blood transfusion with the blood loss ranging from 20 mL to 80 mL;the hospital stay was 7 to 8 days;the ambulation time was 2 days;the drainage pull out time was 3 to 4 days;the discharge time was 7 to 8 days.Conclusion Laparoscopic radical nephrectomy via single-site without pneumoperitoneum is an appropriate minimally invasive surgical strategy of renal cancer,special long clamps and deep long-playing resection control.