经脐单孔腹腔镜在泌尿外科手术中应用的初步体会

Initial experience of transumbilical iaparoendoscopic single-site surgery in urology

目的总结经脐单孔腹腔镜手术在泌尿外科应用的初步经验。方法2010年2月至2011年3月，采用单孔三通道Triport建立操作通道，使用常规腹腔镜器械完成单孔腹腔镜手术21例，其中输尿管切开取石9例，输尿管狭窄切除吻合术5例，肾囊肿去顶术5例，无功能肾切除术2例，术前均明确诊断。依术式在脐部行长1．5～2．5em手术切口建立单孔操作通道，按普通腹腔镜手术步骤进行手术。结果21例手术均在经脐单孔腹腔镜操作下完成，无中转开放手术者。输尿管切开取石手术时间120～230min，平均143min；输尿管狭窄切开再吻合术手术时间120～180min，平均157min；肾囊肿去顶术手术时间95～132min，平均110min；无功能肾切除术分别为95、120min。患者术后1～2d恢复肠道功能，2～3d拔除引流管，术后住院4～7d。术后随访4～6个月，症状减轻或消失，未见明显并发症。结论经脐单孔腹腔镜手术安全可靠，具有手术创伤小、术后恢复快、手术切口美观等优点，适合逐步推广使用。

Objective To summarize the initial experience of transumbilical laparoendoscopic single-site surgery of urology. Methods From February 2010 to March 2011 , 21 patients underwent laparo-endoscopic single-site surgery using transumbilieal single-site and common surgical instruments of laparoen-doseopie. Nine patients underwent single-site laparoscopic ureterolithotomy, 5 underwent transumbilical single-site laparoseopic ureteral stricture resection and anastomosis, 5 underwent transumbilical single-site laparoscopic renalcyst unroofing and 2 had a nephrectomy. All of the cases were definitely diagnosed. A single umbilical incision of 1.5 cm to 2.5 cm was made for Triport. The procedures were performed according to the methods used in classical laparoseope methods using general instruments. Results All the operations were successfully completed without conversion to open surgery. The mean operative time of ureterolithotomy was 143 （120-230） min, the mean operative time of ureteral stricture resection and anastomosis was 157 （120 -180） rain, the mean operative time of unroofing of renal cysts was 110 （95 -132） rain, and the operative time of the nephrectomy was from 95 to 120 rain. The intestinal tract function recovered within 1 - 2 d, the drainage tube was removed within 2 -3 d and the postoperative hospitalization duration was 4 - 7 d. The symptoms were reduced or disappeared and no major intraoperative or postoperative complications occurred within 4 -6 months. Conclusions Transumbilical laparoendoscopic single-site surgery represents a safe and feasible operation for urologic patients. With more clinical practice, laparoendoscopic single-site surgery could be generally applied.