手辅助腹腔镜肾切除术在泌尿外科中的应用:单中心15例报告

Application of hand-assisted laparoscopic nephrectomy in urological surgery:experience of 15 cases in a single center

目的观察手辅助腹腔镜肾切除术的临床疗效。方法共15例符合肾切除术标准的患者进行了手辅助肾切除术,收集患者术前统计学资料、手术时间、出血量、中转开放、术后并发症等指标。结果15例患者包括肾结核(7例)、疑似输尿管下段肿瘤术后证实为肾、输尿管结核(1例)、肾结石并肾积水感染(6例)以及输尿管狭窄并脓肾(1例)。手术时间为68~189(93.0±29.8)min,出血量10~330(79.3±87.9)mL,没有患者输血及中转开放手术。术后并发症包括发热(1例)、持续腹胀(3例)、镇痛药物应用(3例)、持续尿漏(1例),均为Clavien 1级的轻微并发症,保守治疗后消失,没有患者出现Clavien 2~5级的并发症。结论手辅助腹腔镜切除术结合开放手术和腹腔镜手术的优点,是一种安全有效的肾脏切除手术方式,为腹腔镜肾切除术提供了一种替代方法。

Objective To observe the clinical effect of hand-assisted laparoscopic nephrectomy(HALN) in urological surgery. Methods From March 2017 to October 2017, 15 patients with indications for nephrectomy received HALN and tomographic, intraoperative and postoperative data and complications were recorded. Results There were 15 patients, including 7 patients with renal tuberculosis, 1 patient suspected cancer of lower ureter( renal and ureteral tuberculosis identified postoperatively), 6 patients renal calculi with hydronephrosis and infection and 1 ureteral stenosis with pyonephrosis. Mean operation time was (93.0±29.8)min and mean hemorrhage was (79.3±87.9)mL with no conversion to open surgery or blood transfusion in any patient. Postoperative complications were mainly Clavien grade 1, including fever (n=1), prolonged abdominal distention (n=3), pain which need analgesics (n=3) and prolonged urinary leakage which disappear two weeks later. There were no Clavien grade 2 to 5 complications. Conclusions HALN converges advantages of LN and open nephrectomy (ON) and is an effective and safety procedure, thus it could be a substitute for laparoscopic nephrectomy(LN).