改良Pfannenstiel切口取肾的经腹途径腹腔镜肾癌根治术

Transabdominal laparoscopic radical nephrectomy of modified Pfannenstiel incision

目的：评价北京大学第三医院经改良Pfannenstiel切口取肾的经腹途径腹腔镜肾癌根治术治疗肾肿瘤的安全性和疗效.方法：分析12例2012年8月至2013年7月由同一术者应用经腹腔途径行腹腔镜肾癌根治术的患者资料,其中男9例,女3例;左侧9例,右侧3例;年龄44～72岁.患侧卧位,腰部垫高,向背侧倾斜,于脐旁作一约2 cm的切口,依次切开皮肤直至腹膜,直视下置入11 mm穿刺器（trocar）建立气腹.放入30＆#176;腹腔镜,监视下于右侧腹直肌旁肋缘下3 cm处、髂棘内侧、肋缘下腋前线处穿刺分别置入穿刺器,左侧于前2点置入2枚穿刺器.用Hem-o-lok处理肾蒂,切除标本后置入取物袋,在患侧耻骨上2 cm沿皮肤横纹切口（改良Pfannenstiel切口）取出.结果：手术顺利完成,无中转开放及严重并发症.手术时间106～ 234 min,出血量20 ～ 500 mL.病理结果：肾透明细胞癌10例,Ⅱ型乳头状肾癌1例,透明细胞癌与乳头状肾癌并存1例,1例术后5个月因远处转移死亡,余病例术后随访9～ 20个月至今无复发.结论：经腹途径腹腔镜肾癌根治术后通过耻骨上改良Pfannenstiel切口取出标本安全可行,美观效果好,术后疼痛更轻.

Objective：To evaluate the efficacy and safety of transperitoneal laparoscopic radical ne- phrectomy with the modified Pfannenstiel incision. Methods： Between Aug. 2012 and Jul. 2013, the same surgeon performed transperitoneal laparoscopic radical nephrectomy for 12 patients with renal masses. The approach was usually performed through 3 ports or 4 ports placed in a traditional manner. After laparoscopic radical nephrectomy was completed, and the specimen was entrapped in a specimen re- trieval bag, a 7 cm modified Pfannenstiel skin incision was made over the symphysis pubis, lateralized slightly toward the side of surgery. Results： All the procedures were completed without conversion to open radical nephrectomy. The operative time was 106 to 234 minutes and the blood loss was minimal. There was no intra- or post-operative complications. One patient died of multiple organ metastasis after The pathological result was renal cell carcinoma. 5 months. No recurrence was seen after 9 to 20 months＇ follow-up. Conclusion：Laparoscopic radical nephrectomy with the modified Pfannenstiel inci- sion where the kidney is removed offers the benefits of improved cosmesis over the traditional muscle-cut- ting extension of an upper abdominal, lateral port site. The modified Pfannenstiel incision combines the advantages of a low abdominal incision and improved cosmesis, and can be considered a potential alterna- tive for traditional laparoscopic nephrectomy.