单孔和传统腹腔镜肾切除术的比较

Comparison of the clinical data between laparoendoscopic single-site nephrectomy and conventional laparoscopical nephrectomy

目的对比分析单孔腹腔镜和传统三孔腹腔镜肾切除术的临床资料,以探讨单孔腹腔镜在泌尿外科运用的安全性和有效性。方法通过回顾性分析15例单孔腹腔镜肾切除术和20例传统腹腔镜肾切除术患者的手术时间、术中失血量、术后肠通气恢复时间、术后留置引流管时间、术后住院天数等临床数据。结果两组患者在年龄[(53±13)岁vs(51±11)岁,P=0.773],体质量指数[(22.1±2.6)kg/m^2 vs(22.7±3.3)kg/m^2,P=0.535],性别、病理类型、手术路径、术中失血量[(142±74)ml vs(138±60)ml,P=0.861)],术后肠通气恢复天数[(2.0±0.7)d vs(2.0±0.6)d,P=1.000],术后留置引流管天数[(3.5±0.9)d vs(3.2±1.1)d,P=0.453],术后住院天数[(7.1±2.2)d vs(6.8±1.6)d,P=0.729]等方面无明显区别。单孔组14例患者成功的完成了单孔腹腔镜手术,没有增加额外的Trocar,1例中转为三孔腹腔镜后,完成了手术。但单孔腹腔镜手术时间比传统腹腔镜更长[(231±52)min vs(157±30)min,P<0.01],无切口感染病例,短期随访没有切口疝,疤痕也较小。结论单孔腹腔镜肾切术,无论经腰和经腹途径都是安全和有效的。能满足患者对切口美观的要求。但学习曲线及手术时间较长,随着手术技巧的提高和手术器械的改进,或许能有效的解决这个问题。

Objective To compare the clinical data of the laparoendoscopic single-site nephrectomy （LESS） and traditional three holes laparoscopic nephrectomy, for investigating the safety and effectiveness of single-site laparoscopic in the urological utility. Methods The operative time, intraoperative blood loss, postoperative recovery time of intestinal ventilation,postoperative indwelling drainage tube time, postoperative hospitalization days of clinical data of 35 cases were analyzed retrospectively, 15 cases underwent single-site laparoscopic nephrectomy, and 20 cases underwent traditional laparoscopic nephrectomy （TCL）. Result There was no difference between the 2 groups in the age [（53±13） years old vs （51 ±11） years old, P=0.773], body weight[（22.1 ±2.6） kg/m^2 vs （22.7±3.3） kg/m^2, P=0.535], gender distribution, classification of pathology, operative access, intraoperative blood loss[（142±74） ml vs （138± 60） ml, P=0.861）], recovery of intestinal ventilation [（2.0±0.7） d vs （2.0±0.6） d, P=1.000], postoperative indwelling drainage tube [（3.5±0.9） d vs （3.2±1.1） d, P=0.453] and hospital stay [（7.1±2.2） d vs （6.8±1.6） d, P=0.729]. Fourteen of the 15 patients in the LESS group underwent the procedure successfully without additional trocar placement. LESS nephrectomy took longer operative time than TLC group [（231 ±52） min vs （157±30） min, P〈0.01）. No wound infection occurred after LESS nephrectomy. No access site hernia was noted in the patients in the LESS group at short-time follow-up, and the scar was also small. Conclusion The LESS nephrectomy, whether via lumber or abdomen, is safe and effective comparable to TCL, which can satisfy the beautiful wish of patients to the incision, but the learning curve and operative time was long, with the improvement of surgical technique and the operative instruments, perhaps can effectively solve the problem.