单孔多通道腹腔镜泌尿外科手术单中心临床应用总结

Laparoendoscopic single-site surgery in urology:a single-center experience

目的总结单中心100例次泌尿外科单孔多通道腹腔镜手术的临床疗效和经验。方法自2008年12月至2011年5月,98例患者先后在我科接受单孔多通道(TriPort TM)腹腔镜手术,其中2例患者行双侧手术,共完成各类手术100例次;其中肾癌根治术24例,肾脏部分切除术3例,无功能肾切除术10例,肾囊肿去顶减压术21例,单侧肾上腺切除术12例,输尿管切开取石术6例次,经膀胱前列腺剜除术9例,其他手术15例。收集患者基本信息、围手术期各项临床指标及随访资料并进行分析。结果 100例次单孔多通道腹腔镜手术中,87例手术在不增加任何辅助孔的情况下顺利完成,9例手术增加1个5mm的辅助孔,1例中转传统腹腔镜手术,3例中转开放手术。总体并发症发生率为15%(术中6%,术后9%)。前50例总体并发症发生率为5%,后50例为10%。手术疗效满意,美容效果好,肿瘤患者术后平均随访9.9±5.61(3～24)个月,未出现复发或转移。结论单孔腹腔镜技术在泌尿外科的应用安全、可行,创伤小,切口隐蔽。但早期应用阶段仍有一定的并发症发生率,应严格把握手术适应证。随着手术器械的进一步改进、临床经验的不断积累以及优化设计的前瞻性大样本多中心临床随机对照研究的完成,单孔腹腔镜技术将在泌尿外科疾病的诊治中发挥更大的优势。

Objective To present our experience on the first 100 cases receiving urological laparoendoscopic single-site surgery（LESS）.Methods Between Dec.2008 and May 2011,a cohort of 98patients received a total of 100TriPort TM LESS urologic surgeries for various indications,including 2patients undergoing bilateral surgeries.The proceducres included radical nephrectomy（n=24）,partial nephrectomy（n=3）,simple nephrectomy（n=10）,kidney cyst excision（n=21）,adrenlectomy（n=12）,transvesical simple prostatectomy（n=9）,ureterolithotomy（n=6）,and others（n=15）.The demographics,perioperative outcomes,and follow-up data were prospectively analyzed.Results Of the 100surgeries,87were smoothly completed.A 5mm ancillary trocar was required in 9cases.Conversion to standard laparoscopy and open surgery were needed in 1and 3patients,respectively.The overall complication rate was 15%,with 6%intraoperatively and 9% postoperatively.The complication rate was 5%for the first 50cases and 10%for the second 50cases.The patients were followed up for 9.9± 5.61（ranging 3-24）months.At the latest follow-up,all patients remained clinically healthy with a delightedly hidden scar.No evidence of recurrence or metastasis was detected in patients receiving tumor resection.Conclusion The LESS is safe and technically feasible for urological surgery,with minimal invasiveness and better cosmesis.Emphasis should be made on patient selection and indication criteria.Improvement in instrumentation,accumulation of clinical practice,and well-designed multicenter prospective clinical trials will promote the use of LESS surgery for treatment of urologic diseases