摘要
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°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.
出处
《北京大学学报(医学版)》
CAS
CSCD
北大核心
2014年第4期638-641,共4页
Journal of Peking University:Health Sciences
基金
北京大学第三医院回国人员启动基金(78472-02)资助~~