经腹腔途径单孔腹腔镜下肾切除术的临床研究

Clinical application of transperitoneal laparoendoscopic single-site nephrectomy

目的探讨经腹腔途径单孔腹腔镜手术（1aparoendoscopic single—sitesurgery，LESS）行肾切除术的可行性及安全性。方法2010年11月至2012年6月应用4通道单孔腹腔镜行肾切除术患者6例。年龄34～77岁，平均57岁。体质指数（body mass index，BMI）20．1～30．3kg／m。，平均24．2kg／m。。术前诊断肾肿瘤4例，左肾盂肿瘤1例，无功能肾1例。其中。肾肿瘤1例为右侧中央型4．2cm肾肿瘤，另3例分别为左肾下极7．4cm肿瘤、左肾中部4．5cm肿瘤和左肾中部4．3cm肿瘤。全麻下健侧60。卧位，经患侧脐缘切口将单孔腹腔镜通道Quadport置人腹腔，采用5mm头部可弯腹腔镜、标准腹腔镜直器械及预弯器械实施手术。记录手术时间、估计术中出血量、术中并发症、术后第1天疼痛指数（visualanalogpainscale，VAPS）、留置引流管时间、术后住院时问和术后病理等临床资料。结果本组6例手术均顺利完成，无中转为标准腹腔镜或开放手术者，无另加操作通道者。手术时间145．0～235．0min，平均181．7min；估计术中出血量20．0—150.0 ml，平均78．3ml；VAPS1．0～2．0分，平均1．7分；术后留置引流管时间1．O-4．0d，平均2．8d；术后住院时间1．0～10．0d，平均6．8d。术中无严重并发症，术后无继发性出血和切口感染。病理诊断为肾透明细胞癌3例，肾嫌色细胞癌1例，肾盂尿路上皮癌1例，萎缩肾1例。肿瘤患者均未发现淋巴结转移。结论经腹腔途径单孔腹腔镜下肾切除术临床可行性和安全性良好。

Objective To verify the safety and feasibility of applying transperitoneal laparoendo- scopie single-site surgery （LESS） nephrectomy in the treatment of kidney malignant and benign diseases. Methods From Nov. 2010 to Jun. 2012, we had used LESS nephreetomy technique treated four kidney tumors, one renal pelvic tumor and one atrophic kidney. Quadport was introduced into abdominal cavity through a paraumbilieal incision. Conventional laparoscopic instruments, prebent laparoscopic instruments and flexible tip 5mm laparoseope were used. The standard laparoscopie transperitoneal nephrectomy tech- nique was then performed. We evaluated this technique in respects of operative time, estimated blood loss, intraoperative complications, 1st post-operative day pain （VAPS） , drainage time, post-operative hospital stay and pathological results. Results The 6 procedures in this group were completed successfully with LESS nephrectomy. There was no additional troear added, no conversion to conventional laparoscopic or open surgery. Application of Quadport and prebent instruments reduced the clash of instruments, both intra- corporally and extracorporally. The average operative time were 181.7 （145.0-235.0） min, average esti- mated blood loss were 78.3 （20.0 - 150.0） ml. There was no severe intraoperative complication. The aver- age VAPS in the first post - operative day was 1.7 （ 1.0 - 2.0）. The average drainage time was 2.8 （ 1.0 - 4.0） d, post-operative hospital stays was 6.8 （1.0 -10.0） d. There was no secondary bleeding or woundinfection. Pathological results showed 3 cases of renal clear cell carcinoma, 1 case of chromophobic carcino- ma, 1 case of high-grade urothelial carcinoma and 1 case of atrophic kidney. All the specimens in this group were surgical margin negative. Conclusions LESS nephrectomy is a safe and feasible treatment option for the treatment of kidney surgical diseases.