经脐切口单孔腹腔镜和标准腹腔镜治疗肾囊肿的比较

Comparison of natural orifice transumbilical endoscopic surgery versus conventional laparoscopic surgery in renal cyst deroofing

目的 比较经脐切口单孔腹腔镜（NOTES）和标准腹腔镜治疗肾囊肿的安全性及可行性.方法 收集自2010年5月至2011年8月经脐切口单孔3通道（Triport）腹腔镜治疗8例肾囊肿（A组）,应用标准腹腔镜治疗肾囊肿14例（B组）.记录患者年龄、囊肿大小、手术时间、估计术中出血量、术中并发症、留置引流管时间、术后疼痛指数（VAPS）、术后住院时间等临床资料,并对结果进行分析.结果 A组、B组患者囊肿的平均直径分别是：（6.6±2.4）、（7.0±2.5） cm,两组患者均无转为开放手术完成的病例,NOTES组亦无转为标准腹腔镜的病例.A组、B组平均手术操作时间分别为49、35 min,估计术中出血量分别为12、10 ml.患者术后留置引流时间分别各为1d,术后第1天VAPS分别为0、1分,术后住院时间分别为4、5d.两组手术无术中严重并发症,术后无继发性出血和切口感染病例.术者和患者均认为经脐切口手术瘢痕明显较标准腹腔镜3个切口美观.结论 NOTES治疗肾囊肿的安全性和可行性和标准腹腔镜相当,比标准腹腔镜更加符合微创美观的现代手术要求.

Objective To compare the safety and feasibility of natural orifice transumbilical endoscopic surgery （NOTES） versus conventional laparoscopic surgery in renal cyst deroofing.Methods From May 2010 to August 2011,8 cases of renal cysts underwent cyst deroofing by the technique of NOTES （Triport） （group A） and 14 cases by conventional laparoscopic surgery （Group B） respectively.The data of patient age,cyst size,operative duration,estimated blood loss,intra-operative complications,drainage duration,post-operative pain score （VAPS） and post-operative hospital stay were recorded and analyzed.Results The average cyst sizes of groups A and B were 6.6 ± 2.4 and 7.0 ± 2.5 cm.There was no conversion to open surgery in neither groups and no conversion to standard laparoscopic surgery in group A.The operative duration,estimated blood volume,VAPS and post-operative hospital stay of both groups were 49 vs 35 min,12 vs 10 ml,0 vs 1 and 4 vs 5 days respectively.The drainage duration was 1 day for both groups.No severe complication,secondary hemorrhage or wound infection occurred in neither groups.As judged by both surgeons and patients,the post-operative cosmetic appearances of group A were better than those of group B.Conclusion The cyst deroofing by NOTES is a safe and feasible option for the treatment of renal cysts. As compared with conventional laparoscopic surgery,NOTES may achieve better cosmetic effects with smaller wounds.