单切口经脐三角腹腔镜与传统经腹腹腔镜在肾切除中的应用比较

Application of single incision triangulated umbilicus surgery vs.traditional laparoscopy in nephrectomy

目的单切口经脐三角腹腔镜手术(SITUS)已经成功的应用于肾切除、肾部分切除、肾上腺肿瘤切除、膀胱癌根治术和前列腺癌根治术,并显示出其在美容效果和学习曲线上的优势。本文总结了SITUS与传统腹腔镜肾切除术(LN)的异同,以探讨SITUS在肾切除手术的可行性、安全性是否存在优势。方法通过回顾性分析对2015年8月至2017年9月期间实施的25例SITUS肾切除术及29例传统经腹腹腔镜肾除术手术时间、术中失血量、术后留置引流管时问、术后住院天数、PASQ评分等临床数据进行总结分析。结果 54例患者均顺利完成手术。两组手术方式在腹腔内操作时间、术中失血量、术后拔除引流管时间、术后住院天数等方面无明显区别。术后SITUS手术的伤口隐藏于脐周,美容效果良好,而LN术式则在腹部遗留多处腹腔镜通道瘢痕及取出标本的手术切口瘢痕。术后6个月的PASQ评分SITUS手术显著优于LN手术。然而SITUS手术总时间是明显高于LN手术,因其建立和关闭切口的时间要明显长于LN手术。结论 SITUS手术方式进行肾切除手术安全可行,术后瘢痕可隐藏于脐周围。尤其对于大体积肾肿瘤患者,SITUS除了具有美容优势,还具有功能恢复上的优势。

Objective Laparoscopic single incision triangulated umbilical surgery （SITUS） has been successfully applied in renal resection,partial nephrectomy,adrenalectomy,radical cystectomy and radical prostatectomy,showing advantages in cosmetic effects and learning curve.This essay summarized the utilization of SITUS technique in renal resection,compared with traditional laparoscopy nephrectomy （LN）,and explored its feasibility and safety. Methods A total of 25 cases undergoing SITUS and 29 cases undergoing LN during Aug.2015 and Sep.2017 were enrolled.The operation time,estimated blood loss,length of drainage tube indwelling,length of postoperative hospital stay,and PASQ cosmetic score were compared between the two groups. Results All operations were successful.There were no significant differences in the intra-abdominal operation time,estimated blood loss,length of drainage tube indwelling,and length of postoperative hospital stay between the two groups.The incisions of SITUS were hidden in the umbilicus,showing good cosmetic effect,while LN could leave several scars of laparoscopic channels and surgical incisions on the abdomen.Six months after surgery,the PSAQ cosmetic score of the SITUS group was significantly higher than that of the LN group.However,the total operation time was much longer in the SITUS group,as opening and closing the incisions needed more time. Conclusion SITUS is safe and feasible in nephrectomy.The scars can be hidden in the umbilicus.SITUS has the advantage of functional recovery in addition to its cosmetic advantage,especially for patients with large adrenal tumors.