单孔腹膜后镜上尿路肿瘤根治术初步经验总结

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (1034 KB)
输出: BibTeX | EndNote (RIS)

摘要 目的:探讨采用自制套管进行单孔腹膜后镜上尿路肿瘤根治性手术的可行性和初步经验。方法:2010年7月~2011年7月,采用单孔腹膜后镜上尿路肿瘤根治性手术行肾癌根治术5例、肾输尿管全长切除术7例。均选择腋中线与腋前线之间髂嵴上方3 cm处斜行切口,先以气囊扩张建立腹膜后腔,然后置入以手套自制多通道套管建立手术入路,采用前端可弯曲腹腔镜器械联合常规腹腔镜器械完成手术,术毕延长切口取出标本或另取切口完成手术并取出标本。结果:12例手术均顺利完成,无中转开放手术或增加附加套管。平均腔镜手术时间94(60~191)min,术中平均出血83(0~400)ml。平均术后住院7(5~10)d。术后1例(8.3%)发生泌尿系感染,余无并发症发生。结论:对于选择合适的病例,采用自制套管行单孔腹膜后镜肾癌根治术和肾输尿管全长切除术安全可行,但远期疗效有待观察,手术器械及手术技术尚待完善。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	方冬
	郝瀚
	张崔建
	虞巍
	张争
	李学松
	周利群

关键词 ：单孔腹腔镜, 腹膜后镜, 肾癌根治术, 肾输尿管全长切除术

Abstract：Objective:To present clinical experience of retroperitoneal laparoendoscopic single-site (LESS) upper urinary tract radical surgery using self-made single-port device.Methods:Between July 2010 and July 2011, a total of 12 patients underwent retroperitoneal LESS upper urinary tract radical surgery by one experienced surgeon, including 5 radical nephrectomy and 7 nephroureterectomy. All procedures were carried with retroperitoneum through an incision 3 cm above the iliac crest. After extending the retroperitoneum with a ballonet, a self-made single-port device was placed and surgery procedures were performed with flexible and standard laparoscopic instruments. All specimens were extracted through the extended incisions or a separated incision.Results:All procedures were completed successfully, with no conversion to standard multiport laparoscopic or open surgery. The mean laparoscopic operation time was 94(60-191)mins, and the mean estimated blood loss (EBL) was 83(0-400)ml. Postoperative hospital stay was 7(5-10) days. One patient (8.3%) was noted to have urinary tract infection post-operatively.Conclusions:For properly selected patients, the retroperitoneal LESS radical nephrectomy and nephroureterectomy is safe and feasible,but observation for long-term outcome as well as improvements of the instruments and surgical technique are needed.

Key words： laparoendoscopic single-site surgery retroperitoneoscopy radical nephrectomy nephroureterectomy

收稿日期: 2012-09-01

ZTFLH:

R699.2

通讯作者: 周利群,zhoulqmail@china.com

引用本文:

方冬, 郝瀚, 张崔建, 虞巍, 张争, 李学松, 周利群. 单孔腹膜后镜上尿路肿瘤根治术初步经验总结[J]. 微创泌尿外科杂志, 2013, 2(1): 15-18.
Fang Dong, Hao Han, Zhang Cuijian, Yu Wei, Zhang Zheng, Li Xuesong, Zhou Liqun. Retroperitoneal laparoendoscopic single-site upper urinary tract radical surgery: Initial experience. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2013, 2(1): 15-18.

链接本文:

http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1093.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2013/V2/I1/15

[1]Ryu DS, Park WJ, Oh TH. Retroperitoneal Laparoendoscopic Single-Site Surgery in Urology: Initial Experience. J Endourol, 2009,23(11):1857-1862.
[2]Pak CH, Baik S, Kim CS. Initial experience with retroperitoneal laparoendoscopic single-site surgery for upper urinary tract surgery.Korean J Urol,2011,52(12):842-846.
[3]Raman JD, Bensalah K, Bagrodia A, et al. Laboratory and clinical development of single keyhole umbilical nephrectomy. Urology, 2007, 70(6):1039-1042.
[4]Ponsky L, Cherullo E, Sawyer M, et al. Single Access Site Laparoscopic Radical Nephrectomy: Initial Clinical Experience. J Endourol, 2008, 22(4):663-665.
[5]Desai MM, Berger AK, Brandina R, et al. Laparoendoscopic single-site surgery: initial hundred patients. Urology, 2009,74:805-812.
[6]White WM, Haber GP, Goel RK, et al. Single-port urological surgery: single-center experience with the first 100 cases. Urology, 2009,74:801-804.
[7]Stolzenburg JU, Kallidonis P, Hellawell G, et al. Technique of laparoscopic-endoscopic single-site surgery radical nephrectomy. Eur Urol, 2009,56:644-650.
[8]Stolzenburg JU, Hellawell G, Kallidonis P, et al. Laparoendoscopic single-site surgery: Early experience with tumor nephrectomy. J Endourol, 2009,23:1287-1292.
[9]Stolzenburg JU, Do M, Haefner T, et al.Laparoendoscopic Single-Site Surgery Radical Nephrectomy. J Endourol, 2011, 25(2):159-165.
[10]Park YH, Park SY, Kim HH. Laparoendoscopic single-site nephroureterectomy with bladder cuff excision for upper urinary tract transitional-cell carcinoma: technical details based on oncologic principles.J Endourol,2010,24(4):563-566.
[11]Seo IY, Hong HM, Kang IS, et al. Early experience of laparoendoscopic single-site nephroureterectomy for upper urinary tract tumors. Korean J Urol,2010,51(7):472-476.
[12]方冬,郝瀚,瓦斯里江·瓦哈甫,等.自制套管单孔腹膜后镜肾上腺切除术初步经验总结.中华临床医师杂志(电子版),2012,6(9):112-115.
[13]Lin T, Huang J, Han J, et al. Hybrid laparoscopic endoscopic single-site surgery for radical cystoprostatectomy and orthotopic ileal neobladder: an initial experience of 12 cases. J Endourol, 2011, 25(1): 57-63.
[14]Raman JD, Bagrodia A, Cadeddu JA, et al. Single-Incision, umbilical laparoscopic versus conventional laparoscopic nephrectomy: a comparison of perioperative outcomes and short-term measures of convalescence. Euro Urol, 2009, 55:1198-1206.
[15]David C, Andre B, Monish A, et al. Laparo-endoscopic single site(LESS) versus standard laparoscopic left donor nephrectomy: matched-pair comparison. Euro Urol, 2010,57:95-101.
[16]Zhang X, Shi TP, Li HZ, et al. Laparo-endoscopic single site anatomical retroperitoneoscopic adrenalectomy using conventional instruments: initial experience and short-term outcome. J Urol, 2011, 185(2):401-406.
[17]Micali S, Isɡrò G, De Stefani S, et al. Retroperitoneal laparoendoscopic single-site surgery: preliminary experience in kidney and ureteral indications. Eur Urol, 2011,59(1):164-167.
[18]White WM, Goel RK, Kaouk JH. Single-port laparoscopic retroperitoneal surgery: Initial operative experience and comparative outcome. Urology, 2009,73(6):1279-1282.
[19]胡成,司徒杰,黄文涛,等.单孔腹腔镜在腹膜后手术中的初步应用.中华腔镜泌尿外科杂志(电子版),2011,5(1):18-21.