经脐单孔腹腔镜肾癌根治术20例经验报道

Transumbilical single-port laparoscopic radical nephrectomy: experience with 20 cases

目的总结经脐单孔多通道腹腔镜下肾癌根治术的临床经验并评估手术疗效。方法 2010年9月～2011年8月完成经脐单孔多通道腹腔镜下肾癌根治术20例(左侧14例,右侧6例;均为T1期)。取2～3cm皮肤切口,按TriPortTM使用说明置入单孔多通道组合套件,在5mm一体化腹腔镜下,通过普通腹腔镜器械和可弯器械相配合,完成手术,切除标本经适当延长皮肤切口后取出。收集患者基本信息、围手术期各项临床指标及随访资料。结果 20例手术均顺利完成,无1例增加辅助通道。平均手术时间95(60～150)min,平均术中出血量100(50～200)mL,术中术后均未输血。所有患者术后第1天开始进食,仅8例(40%)患者术后使用镇痛药物,术后24h视觉模拟疼痛评分2～6分,出院时视觉模拟疼痛评分0～2分,术后平均住院时间4.8(3～8)d。无任何术中、术后并发症。术后病理结果均为肾细胞癌。术后定期随访无1例出现肿瘤复发或转移,手术切口隐蔽。结论经脐单孔腹腔镜下肾癌根治术安全有效,术后疼痛轻,且瘢痕隐蔽,但其长期临床疗效尚需前瞻性大样本多中心临床随机对照研究进一步证实。

【Objective】 To summarize our experience with transumbilical single-port laparoscopic radical nephrectomy and evaluate the surgical outcomes.【Methods】From September 2010 to August 2011, 20 transumbili-cal single-port laparoscopic radical nephrectomies (14 in left side and 6 in right side, all are stage T1 disease) were performed through a 2-3-cm skin incision using the TriPortTM access system. Under the 5-mm integrative laparo-scope, traditional laparoscopic instruments and flexible instruments were utilized to complete the operation. The re-sected tumor was taken out through the extended umbilical incision. The patients' data, perioperative outcomes and followup data were collected.【Results】All operations were successful, no additional port was needed in any opera-tion. The mean duration of the operation was 95(60-150) minutes and the mean blood loss was 100(50-200) ml. No blood transfusion was required during or after the operation. All patients were allowed to take food at day 1 postop-eratively. Only 8 patients (40%) needed pain medicine after the operation. The Visual Analogue Pain Score was 2-6points at 24h postoperatively and 0-2 points at discharge. The mean hospitalization time was 4.8 (3-8) days. There was no complication during or after the operation. All cases were pathologically diagnosed as renal cell carcinoma. There was no tumor recurrence or metastasis during the regular follow-up. The surgical incision was barely notice-able.【Conclusions】Transumbilical single-port laparoscopic radical nephrectomy is safe and effective. The postop-erative pain is minimal and the scar is barely noticeable. However, prospective and multicenter randomized con-trolled trials are needed to further validate its long-term outcomes.