自制单孔多通道装置在泌尿外科单孔后腹腔镜手术中的应用(附167例报告)

The Application of a Home-made Single-port with Multi-channel in Single-port Retroperitoneal Laparoscopic Urological Surgery( A Report of 167 Cases)

目的探讨自制单孔多通道装置在泌尿外科单孔后腹腔镜手术中的应用。方法回顾分析了从2011年6月至2014年5月笔者进行单孔后腹腔镜单纯肾切除术57例、单孔后腹腔镜肾癌根治术35例、单孔后腹腔镜肾上腺切除术36例、单孔后腹腔镜肾囊肿去顶术39例,共167例患者的临床资料。均采用1个切口保护套和1个无粉外科手套组成一个单孔多通道操作装置,使用常规腹腔镜器械进行单孔后腹腔镜手术,术后手术伤口常规予皮内缝合。结果 167例患者均成功进行单孔后腹腔镜手术,无改行常规后腹腔镜手术或开放手术。单孔后腹腔镜单纯肾切除术手术时间(90.0±38.2)分钟,单孔后腹腔镜肾癌根治术手术时间(120.0±33.7)分钟,单孔后腹腔镜肾上腺切除术手术时间(45.0±16.3)分钟,单孔后腹腔镜肾囊肿去顶术手术时间(35.0±15.6)分钟。术中出血量20~200ml,术后无需要输血患者,无重大手术并发症。所有患者均对手术伤口愈合后残留的微小瘢痕感到满意。结论应用自制单孔多通道装置进行泌尿外科单孔后腹腔镜手术安全可行、费用低,减少手术创伤。联合伤口皮内缝合,达到了患者的美观要求,应用前景广阔,可作为有手术伤口美观要求的患者,特别是女性患者行相关手术的首选治疗方法。

Objective To present our initial experience and study the safety,efficacy and feasibility of home-made single-port of multi-channel in single-port retroperitoneal laparoscopic urological surgery. Methods We retrospectively studied 167 patients who underwent single-port retroperitoneal laparoscopic urological surgery in our medical team in the Department of Urology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,from June 2011 to May 2014. Of these,57 patients underwent nephrectomy,35 patients underwent radical nephrectomy,36 patients underwent adrenalectomy,and 39 patients underwent renal cyst surgery. The device included an incision protective sleeve and a powder-free surgical glove,which can form a single-port of multi-channel operation equipment. The single-port retroperitoneal laparoscopic urolog-ical surgeries were conducted with conventional laparoscopic instruments. The incisions were sewed with intradermal suture routinely. Results All the 167 patients underwent single-port retroperitoneal laparoscopic surgery,no conversion to conventional retroperitoneal laparoscopic surgery or open surgery. All cases were completed successfully. The mean operative time of nephrectomy was( 90. 0 ± 38. 2) minutes. The mean operative time of radical nephrectomy was( 120. 0 ± 33. 7) minutes. The mean operative time of adrenalectomy was( 45. 0 ±16. 3) minutes. The mean operative time of renal cyst surgery was( 35. 0 ± 15. 6) minutes. The blood loss was20 ml to 200 ml for the operation. All the patients did not have any major complications. All patients were satisfied with the tiny scar after operation. Conclusions Application of home-made single-port with multi-channel in single-port retroperitoneal laparoscopic urological surgery is safe,feasible,and low cost. It meets to the appearance requirements of patients combined with intradermal suture,and has wide application prospect. Single-port retroperitoneal laparoscopic urological surgery is recommended to applicate for the patients with appearance requirements especially for the female patients.