经脐单孔腹腔镜治疗双侧肾囊肿(附10例报告)

Single-port transumbilical laparoscopic surgery for the treatment of 10 patients with bilateral renal cysts

目的:探讨经脐单孔腹腔镜治疗双侧单纯性肾囊肿的临床应用价值。方法:回顾性分析对本院自2010年2月～至2011年12月收治的10例双侧单纯性肾囊肿患者临床资料,所有均施行经脐单孔腹腔镜下双侧肾囊肿去顶减压术。其中男4例,女6例,年龄47～70岁,囊肿直径(7.70±1.54)cm。本组患者9例双侧囊肿位于肾脏腹(外)侧,仅1例单侧囊肿位于肾盂旁,均适合此手术方式。于脐部作一2～3cm切口建立自制单孔操作通道,切开结肠旁沟处的侧腹膜,游离并暴露囊肿。在距肾实质约5mm处用超声刀将大部分囊肿壁完整切除,撤出腹腔镜,保留操作通道,改变患者体位并以同样方式处理对侧囊肿。结果:9例顺利完成单孔腹腔镜手术,1例因囊肿位置特殊,术中分离较困难,在合适部位增加一5mm操作通道。手术时间平均(91.7±24.7)min,术中平均出血(38.9±25.8)ml,平均术后住院(3.5±1.7)d,术后平均留置引流管2.1d。术后随访3～12个月,脐部切口愈合良好,囊肿无复发,无脐疝等相关手术并发症产生。结论:采用自制经脐单孔多通道腹腔镜治疗双侧肾囊肿安全可行,手术时间缩短,术后恢复快,术后切口瘢痕隐蔽,具有良好的微创和美容效果,为双侧肾脏病变提供新的手术治疗方式。

Objective： To evaluate the clinical application value of one-stage single-port transumbileal laparoscopic surgery for the treatment of bilateral renal cysts. Method： From Feb. 2010 to Dec. 2011, ten cases patients with bilateral simple renal cysts were treated by self-made tingle-port transumbilcal laparoscopic renal Cystecto- my. 4 patients were male and 6 patients were female, aged from 47 to 70 years. The cysts diameter were （7.70± 1.54） cm. The renal cysts were located in the ventral（or ventrolateral） side in this group of patients, one case＇s cyst located in the peripelvic, suitable for the laparoscopic surgery. Establishing the single-port operation channel through a 2-3 cm umbilical incision, then cut the side peritoneal and separated to expose the cyst and cut the whole cyst wall about 5 mm away from the renal parenchyma by the Ultrasonic scalpel. Keeping the operation channel and changed the position to deal＇ with the other side in the same way. Result.. Nine single-port laparoscopic operations were completed successfully, and one case added a 5 mm operation channel in a appropriate site because the location of the cyst was difficult to separate. The mean operative time was （91.7±24.7） min, mean blood loss was （38. 9± 25.8） ml, the mean postoperative hospital stay were（3.5± 1.7） d, and the mean duration of drainage catheter was 2.1 d. The patients were followed up 3-12 months, during which no complications occurred, and the incision healed well. Conclusion： The self-made laparoscopic single-site transumbilical surgery for bilateral simple renal cysts is safe and feasible, scar hidden, has good cosmetic results and a new clinical treatment method is provided for bilateral renal diseases.