经脐单孔腹腔镜下肾蒂淋巴管剥离术治疗乳糜尿的临床研究

目的 探讨经脐单孔腹腔镜下肾蒂淋巴管剥离术治疗乳糜尿的可行性及初步疗效.方法 采用经脐单孔三通道入路,腹腔镜下对9例乳糜尿患者行肾蒂淋巴管剥离术.于脐部上沿取2～3 cm倒"U"形切口,置入自制单孔三通道装置建立工作通道.肾蒂的解削分离通过可弯曲钳及电凝钩进行;超声刀完成对肾蒂淋巴管的闭合和切断.结果 手术均在腹腔镜下完成,除2例增加1个5 mm套管外,7例手术成功.平均手术时间135(96～178)min;估计出血量平均126(50～250)ml.术后当天9例患者乳糜尿症状均消失;患者仅在脐部留一2.5 cm大小的手术瘢痕;术后随访1～6个月,乳糜尿症状未复发.结论 经脐单孔腹腔镜下肾蒂淋巴管剥离术治疗乳糜尿安全可行、疗效肯定,具有较好的微创美容效果.

Abstract：

Objective To evaluate the feasibility and efficacy of laparoscopic single-port transumbilical renal pedicle lymphatic disconnection (TRPLD) for treatment of chyluria. Methods Nine cases of chyluria underwent laparoscopic single-port TRPLD. In all cases a 2-3 cm single inverted Ushaped supraumbilical incision was made, two 5-mm and one 12-mm trocars were inserted, and a medical rubber glove was sutured surrounding the three trocars and incision was made for gas proofing.Conventional straight and flexible instruments were used for dissection. Results All laparoscopic operations were successfully completed without conversion to open surgery. The mean operative time was 135 (96-178) minutes, and the mean estimated blood loss was 126 (50-250) ml. Chyluria disappeared in all patients after operation and did not reoccur during the follow-up (1 - 6 months).Conclusions Laparoscopic single-port transumbilical TRPLD represents a feasible and novel mini-invasive option for patients with chyluria.     

经脐单孔腹腔镜胆囊切除术的手术经验

目的 研究经脐单孔腹腔镜胆囊切除术临床可行性及安全性.方法 总结2009年2月至2010年12月、82例胆囊疾病患者实施经脐单孔腹腔镜胆囊切除术的经验,并分析手术中碰到的一些疑难问题和应对策略.结果 82例患者中,9例患者由于胆囊周围炎症、胆囊三角解剖困难及胆囊动脉结构变异等原因改行其他术式,其中6例改行二孔法腹腔镜胆囊切除术,3例中转常规开放性手术;其余73例手术均顺利完成单孔手术,成功率89.0%.手术时间平均48.4 min,手术出血平均20.8 ml.术后次日恢复流质饮食,住院3～6 d.术后平均随访13.7个月,均无胆管损伤、大出血、切口感染、胆漏、脐疝等并发症发生,术后复查切口愈合良好,瘢痕极隐蔽而不易察觉.结论 经脐单孔腹腔镜胆囊切除是安全可行的,技术上的难点容易突破.

Abstract：

Objective To study the feasibility and safety of transumbilical single incision laparoscopic cholecystectomy. Methods Eighty-two cases with gallbladder diseases were underwent with transumbilical single incision laparoscopic cholecystectomy. Some difficulties and countermeasure in operations were analyzed. Results Nine in all patients were converted because of the surrounding inflammation of gallbladder, difficult to dissect in Calot's triangulation and variation of gallbladder artery. Of them, 6 cases converted to two-hole laparoscopic cholecystectomy and 3 cases to open operation. Other 73 cases were successfully operated with transumbilical single incision laparoscopic cholecystectomy. The success rate was 89. 0%. The average operative duration was 48.4 min. The average operative blood loss was 20. 8 ml. Patients returned to liquid food on the first day after operation. Hospital duration was 3～6 d. During 13.7 months of follow-up, there was no bile duct injury, large bleeding, incision infection, bile fistula and umbilical hernia. The incision healed well. The scar in umbilicus was concealing and difficult to be observed. Conclusions Transumbilical single incision laparoscopic cholecystectomy is safe and feasible. The difficulties in technique are easy to be broken through.     

单孔腹腔镜下根治性膀胱切除术10例报告

目的 探讨单孔腹腔镜根治性膀胱切除术的可行性及初步经验.方法 采用单孔腹腔镜技术完成根治性膀胱切除术10例.男9例,女1例.取下腹正中3～4 cm切口,置入QuadPort(2例)或自制开口器(2环1套法,8例)建立单孔腹腔镜手术通道,术中采用常规和预弯腹腔镜器械.手术步骤包括双侧标准盆腔淋巴结清扫、根治性膀胱切除及开放构建全去带乙状结肠原位新膀胱.结果 10例手术顺利.无中转开放手术或传统腹腔镜手术,未增加其他通道.单孔部分手术时间130～330 min,平均243 min.术中失血50～600 ml,平均270 ml,5例需输浓缩红细胞2～4 U.盆腔淋巴结、尿道及输尿管切缘均阴性.病理报告均为尿路上皮癌T1N0M0 2例,T2aN0M0 6例,T3aN0M0 2例.无围手术期死亡及严重并发症的发生.8例完成6个月以上的随访,白天排尿均完全可控,4例有夜间遗尿,未见肿瘤复发和远处转移.结论 单孔腹腔镜膀胱癌根治性切除术安全可行,美容效果较好,短期随访肿瘤控制效果好.自制开口器制作简单,操作方便,气密性好,成本低,能够完成单孔腹腔镜手术.

Abstract：

Objective To present our initial experience of pure laparoendoscopic single-site surgery (LESS) for radical cystectomy and bilateral pelvic lymph node dissections. Methods 10 patients with pathology confined bladder urothelial carcinoma underwent laparoendoscopic single-site radical cystectomy, including 9 males and 1 female. After a 3-4 cm lower median abdominal incision was made, quadport or homemade single multichannel port was inserted, and conventional and prebent laparoscopic instruments were utilized. The surgical procedure included bilateral pelvic lymphadenectomies, radical cystectomy and building with a sigmoid orthotopic neobladder by open surgery.Results No extra port needed, neither conversion to open or conventional laparoscopic surgery. The time of LESS procedure ranged from 130 to 330 min (mean 243 nin). Estimated blood loss ranged from 50 to 600 ml (mean 270 ml). 5 patients needed blood transfusion of 2 to 4 units. The pathologic evaluation revealed bladder urothelial carcinoma, negative margins and negative pelvic lymph node involvement. No mortality or severe complications were observed perioperatively. After followup of more than 6 months, all revealed controllable urination at daytime, while 4 revealed nocturnal incontinence and needed one or two pads during nighttime. No evidence of recurrent or metastatic disease was detected. Conclusions LESS radical cystectomy and bilateral lymphadenectomies was safe and feasible, and short-term follow-up showed good tumor control outcomes. Homemade single multichannel port made of two elastic ring and glove was simple and effective.     

经脐单孔腹腔镜肾盂离断成形术临床分析

目的 探讨经脐单孔腹腔镜手术治疗肾盂输尿管连接部狭窄的手术技巧与临床应用价值.方法 2009年8月至2010年3月对15例肾盂输尿管连接部狭窄患者行经脐单孔腹腔镜肾盂离断成形术.男12例,女3例;平均年龄20(12～55)岁.均采用利尿性肾图、IVU、磁共振尿路造形术(MRU)等检查确诊,其中左侧9例,右侧6例.依病变部位在脐患侧缘行长约3.5 cm的切口建立单孔操作通道.采用Olympus四方向可弯曲腹腔镜,主要采用标准腹腔镜器械.肾盂离断成形方法基本同普通腹腔镜方法.结果 手术均成功,无中转开放手术者.平均手术时间为90(75～145)min.术中未出现器官损伤,术后未出现尿漏.患者平均住院时间6(4～8)d.术后随访4～6个月,患者腰痛症状消失,IVU和(或)B超检查肾积水明显减轻或消失,无吻合口再狭窄.结论 经脐单孔腹腔镜手术治疗肾盂输尿管连接部狭窄安全、有效.

Abstract：

Objective To evaluate the surgical techniques and clinical applications of single-port transumlilical laparoscopic dismembered pyeloplasty for the treatment of ureteropelvic junction obstruction (UPJO). Methods From August 2009 to March 2010, 15 patients were treated with single-port transumbilical laparoscopic dismembered pyeloplasty. There were 12 males and 3 females,aged 12 to 55 years with an average age of 20 years, who were diagnosed by diuretic renography,IVU, and MRU et al. A single umbilical incision of 3. 5cm was made for single-port trocar and a flexible-tip 0°digital video-laparoscope was used in all cases. The procedures were performed according to the methods used in classical laparoscopic dismembered pyeloplasty with general instruments. ResultsAll operations were performed successfully without conversion to open surgery. The mean operative time was 90 (75-145) min, and the mean hospital stay length was 6 days. No organs injury occurred during operation, and no urine leakage was found afer operation. The symptoms of low back pain disappeared and hydronephrosis reduced apparently or dispeared without any anastomotic stenosis after follow-up of 4-6 months. Conclusions Single-port transumbilical laparoscopic dismembered pyeloplasty is feasible, effective and safe for the treatment of UPJO.     

腹膜外入路经脐单孔腹腔镜下前列腺癌根治术11例报告

目的 探讨使用自制多通道套管经脐切口行单孔腹腔镜下前列腺根治性切除术的方法及初步疗效.方法 2009年8月至2010年3月,对11例局限性前列腺癌患者行单孔腹腔镜下前列腺根治性切除术.经脐3 cm切口,腹膜前置入自制多通道套管,行单孔腹腔镜下双侧闭孔淋巴结清扫、前列腺根治性切除、膀胱尿道吻合术.膀胱尿道吻合采用活结套结连续缝合法完成.结果 1例增加1个套管,其余10例手术均顺利完成,无中转常规腹腔镜手术或开放手术.平均手术时间256(195～315)min,平均出血量90(20～180)ml,平均术后住院时间15.4(13～24)d,术后12 d拔除尿管.无术中并发症.术后1例出现膀胱尿道吻合口漏、2例出现淋巴漏、1例出现泌尿系感染,均经保守治疗治愈.病理报告11例手术标本切缘均阴性,清扫淋巴结阴性.患者平均随访7(3～11)个月,无肿瘤生化复发.结论 单孔腹腔镜下前列腺根治性切除术技术上可行,具有美观、微创、并发症少的特点,具有良好的短期功能和肿瘤控制效果,中长期疗效需进一步随诊观察.

Abstract：

Objective To present our initial experience in laparoscopic radical prostatectomy performed through an umbilical incision using a home-made multichannel port. Methods From August 2009 to March 2010, we performed single-port laparoscopic radical prostatectomy in 11 patients with localized prostate cancer. A home-made multichannel port was inserted extraperitoneally through a 3-cm umbilical incision. The single port extraperitoneal procedures included obturator fossa lymphadenectomy, radical prostatectomy and urethro-vesical anastomosis, while the urethro-vesical anastomosis was performed by a slip-knot running suture technique. Data were collected and analyzed prospectively. Results All cases were completed successfully, without conversion to a standard laparoscopic approach or open surgery except adding an additional port in one case. The average operative time was 256 minutes (range195-315), and the mean blood loss was 90 ml (range 20- 180), without any blood transfusion. The postoperative hospital stay was 15.4 days (range13- 24), and the Foley catheter was removed 12 days after surgery. No intraoperative complications occurred. One patient developed a vesico-rethralanastomosis leakage, 2 had lymphatic leakage and 1 had urinary tract infection,all of the cases were managed successfully with conservative treatment. Histopathological results showed negative surgical margine and negative lymph node dissection. All patients had no biochemical relapse after an average follow-up of 7 months. Conclusions Single-port laparoscopic radical prosta tectomy is feasible, cosmetic and minimally invasive with a low complication rate and good short-term outcome. Additional investigation is needed to evaluate the long-term safety and oncologic adequacy of this new approach.     

后腹腔镜下肾输尿管全切术治疗肾结核的临床分析

目的 探讨后腹腔镜下肾输尿管全切除术治疗肾结核的可行性和安全性.方法 2005-2009年收治肾结核病患者28例.男18例,女10例.年龄26～51岁,平均36岁.左侧16例,右侧12例.术前经尿查抗酸杆菌、IVU、CT、B超及核素肾图等检查明确诊断为单侧无功能或重度受损肾结核,对侧肾功能正常.术前常规给予异烟肼、利福平和乙胺丁醇三联抗结核用药2周～6个月,无活动性肾外结核,红细胞沉降率正常后行后腹腔镜下肾输尿管全切除术.术中以下腔静脉和左侧输尿管为解剖标记寻找肾蒂血管,以患肾脂肪囊外平面作为游离平面.结果 28例手术均获成功,无中转开放病例.手术时间121～258 min,平均170 min;术中出血量70～250 ml,平均110 ml;术后住院5～14 d,平均5.7 d.术中损伤腹膜3例,术后切口感染2例,术后继续抗结核治疗3个月.24例随访6～20个月,平均12.5个月.患者尿路刺激症状消失,尿常规、红细胞沉降率正常,尿查抗酸杆菌阴性,B超复查对侧肾、输尿管及膀胱等未见结核病灶残留.结论 后腹腔镜下肾输尿管切除术治疗肾结核安全可行,术中通过辨认解剖标记结扎肾蒂血管和沿正确的平面游离患肾是手术成功的关键.

Abstract：

Objective To discuss the feasibility and safety of retroperitoneal laparoscopic nephrectomy for treatment of kidney tuberculosis. Methods From March 2005 to February 2009, 28 patients with kidney tuberculosis underwent retroperitoneal laparoscopic nephrectomy. The patients′ data were reviewed and analyzed. Results There were 18 men and tencwomen with an average age of 36 (26-51) in the cohort. Sixteen patients had lesions on the left kidney and 12 on right kidney. All patients had a normal renal function on the contra lateral side. The severely impaired renal function of the lesion side was confirmed before operation. Anti-tuberculosis chemotherapy was administered to patients for two weeks to six months in advance of the surgery. No active lesion of tuberculosis was found and ESR level was normal before operation. All the operations were successfully performed without switching to open surgery. The average operative time was 170 (121-258) minutes, blood loss was 110 (70-250) ml and average postoperative hospital stay was 5.7 (5-14) days. Peritoneum injury was seen in three patients and incision infection in two patients. No severe complications were observed. Anti-tuberculosis chemotherapy was continued for three months. Twenty-four patients were followed-up, and the average follow-up time was 12.5 (6-20) months. All patients recovered without any lesion remaining. Conclusions Retroperitoneal laparoscopic nephrectomy could be a safe and reliable method for the treatment of non-functioning kidney due to tuberculosis.     

经腹肾癌根治术并系统性淋巴结清扫治疗肾细胞癌临床分析(附136例报告)

目的 评价经腹腔肾癌根治性肾切除术并系统性淋巴结清扫术的安全性和疗效.方法 回顾性分析2004年7月至2008年6月经腹直肌旁切口行根治性肾切除和系统性淋巴结清扫术治疗肾细胞癌136例患者的资料.男92例,女44例;年龄23～81岁,平均54岁.肿瘤最大径15～170 mm,平均55 mm.体检时B超检查发现66例(61%),以皮肤转移为首发症状者2例.术前均进行B超、CT及核素骨扫描检查,肿瘤临床分期:T1 108例,T2 14例,T3 12例,T4 2例.结果 本组手术时间90～180 min,平均120 min.出血量20～400 ml,平均50 ml.术后肠道功能恢复时间为(24±12)h,术后住院天数为(7±2)d.术后病理结果:肾透明细胞癌123例(90.4%),乳头状肾细胞癌6例(4.4%),嫌色细胞癌2例(1.4%),集合管癌2例(1.4%),其他3例(2.2%).淋巴结转移8例.T1期92例,T2期11例,T3期10例,T4期10例.95例(69.9%)获随访,随访时间6～40个月,平均20个月.1、3年生存率分别为95.8%(91/95)、86.3%(82/95).结论 系统性淋巴清扫肾癌根治术能有效切除肿瘤,可准确分期,防止局部复发,安全可靠,疗效良好.

Abstract：

Objective To assess the safety and efficacy of abdominal radical nephrectomy and systematic lymph node dissection for treatment of renal carcinoma. Methods A total of 136 patients underwent radical nephrectomy and regional clearance of lymph nodes from July 2004 to June 2008.There were 92 males and 44 females in the study group.Ages ranged from 23 to 81 years,with a mean age of 54 years.The mean tumor diameter was 55 mm (range,15-170 mm).The tumor size detected by CT and MRI was consistent with that detected by B-ultrasound,98 were stage Ⅰ,13stage Ⅱ,12 stage Ⅲ,and 2 stage Ⅳ. Results All 136 cases underwent radical nephrectomy with retroperitoneal lymphadenectomy.All operations were successful without any major complication.The operative time was 90 to 180 min,with an average of 120 min,and blood loss was 20-400 ml,with an average of 50 ml.The pathological diagnoses were as follows: renal cell carcinoma 123 cases (90%), papillary renal cell carcinoma six cases(4%),chromophobic two cases(1.4%),oncocytoma two cases(1.4%),collecting duct two(1.4%),and others three cases(2.2%).Eight cases reported positive lymph nodes.Of the 136 cases,92 cases were T1 N0 M0,11 were T2 N0 M0,10 were T3 N0 M0,eight were T3 N1 M0 and two were T1 N0 M1.Ninety-five cases (70%) were followed-up at six to 40 months (mean,20 months).The one year and three year survival rates were 96% (91/95) and 86% (82/95),respectively.Conclusions Radical nephrectomy with systematic lymph dissection has advantages of accurate staging,effective resecting of renal tumors and preventing recurrence.Radical nephrectomy is an effective method for the treatment of renal carcinoma.     

多房囊性肾细胞癌的临床分析及其与vonHippel-Lindau基因突变的相关性研究

目的 提高对多房囊性肾细胞癌(MCRCC)的认识及诊治水平,分析MCRCC中von Hippel-Lindau(VHL)基因的作用.方法 回顾性分析2000-2010年17例MCRCC患者资料,占同期收治512例肾癌的3.32%.男11例,女6例.年龄37～61岁,平均46岁.术前常规行B超、CT等检查,误诊为肾盂旁囊肿1例.应用PCR、PCR产物直接测序等方法分析11例MCRCC组织和相应远离病灶的正常组织中VHL基因突变的情况.结果 17例患者行根治性肾切除术14例,其中1例先行囊肿去顶术,术中囊壁组织冰冻病理检查提示透明细胞癌,改行根治性肾切除术;行肾部分切除术3例.肿瘤直径2.2～6.0 cm,平均(3.6±1.2)cm.术后病理均为MCRCC,镜下主要表现为纤维囊壁组织内衬单层或数层肿瘤细胞,核小致密,胞质透亮.TNM分期均为T1N0M0,病理分级G1 14例,G2 3例.术后随访9～36个月,平均12个月,均未见复发及转移.11例MCRCC组织中7例(64%)存在VHL基因突变,而正常组织标本均未发现VHL基因突变.结论 MCRCC作为肾细胞癌的一种少见的独立亚型,病理及临床上易漏诊或误诊.CT等影像学检查有助于术前诊断,因其预后良好,手术方式推荐保留肾单位手术.VHL基因突变与MCRCC的发生存在一定关系.

Abstract：

Objective To discuss the diagnosis and surgical management of multilocular cystic renal cell carcinoma (MCRCC) and to evaluate the gene function of the mutation of von Hippel-Lindau (VHL) gene in MCRCC. Methods Seventeen MCRCC cases (11 men and 6 women) out of 512 cases of renal cell carcinoma from 2000 to 2010 were retrospectively analyzed. The mean age of the 17 patients was 46 years (37-61 years). Ultrasonography and CT were available in all 17 cases, and 1 case was misdiagnosed as parapelvic renal cyst. The mutation of VHL gene was detected by PCR in the specimens of can-cerous tissue and adjacent normal tissue from 11 cases of MCRCC. Results Three of 17 cases underwent nephron sparing surgery, the others underwent radical nephrectomy. One case underwent unroofing of parapelvic renal cyst, but the rapid frozen pathology of the cyst wall showed renal cell carcinoma of clear type. As a result, radical nephrectomy was eventually performed. All 17 cases were confirmed as MCRCC by eva-luating pathological characteristics, such as the cyst wall lined by single or several layers of clear tumor cells and the nuclei which were small and anachromasis. Clinical stages of all cases were T1N0M0, in which there were 14 cases with pathological T1G1 and 3 cases with pathological T1G2. All patients underwent a follow-up of 9 to 36 months (mean, 12 months) without recurrence or metastasis. Mutation of VHL gene was detected in 7 of 11 cases (64%), but all adjacent normal tissues were negative. Conclusions As a rare subtype of renal cell carcinoma, MCRCC is difficult to diagnose. CT is an essential measure in diagnosis of MCRCC preoperatively. Because of the good prognosis of reported cases, nephron sparing surgery for the treatment of MCRCC is recommended. VHL gene mutations may play an important role in the carcinogenesis of MCRCC.     

腹腔镜肝切除术治疗肝血管瘤22例临床分析

Objective To investigate technical features and efficacy of laparoscopic liver resec-tion for hepatic hemangioma. Methods The clinic data of 22 patients with hepatic hemangioma receiv-ing laparoscopic liver resection in our hospital from March 2007 to February 2008 were retrospectively analyzed. Results Twenty patients received successful total laparoseopie liver resection and 2 conver-sion to laparotomy. Anatomical liver resection was performed in 14 patients including 5 with left hemi-hepateetomy, 5 with left lateral segmentectomy (1 combined with radiofrequeney ablation for the tumor in the right liver lobe) and 4 with segment Ⅵ resection. Eight patients underwent nonanatomi-cal hepatectomy. The liver parenchyma of 10 patients were transected under regional hemi-hepatic blood occlusion, 7 under intermittent Pringle's manoeuvre, and 5 without hepatic blood inflow block-age. The mean operative duration was 209 rain (92-375 min) and mean blood loss 360ml (50-1300 ml). No operative death and postoperative complications occurred, and the patients recovered well. The mean postoperative hospital stay was 6 d (4-10 d). All the patients were followed up for 2-14 months and no recurrence was found. Conclusion The advantages of laparoseopie liver resection for hepatic hemangioma are safe operation, less complications, and quick postoperative recovery. The key points are right choice of surgical approach, effective control of hepatic blood inflow, proper man-agement of cutting surface of liver, and liver parenchyma amputation being performed 0. 5-1 cm to tumor margin in the normal parenchyma or anatomical liver resection.     

后腹腔镜手术治疗重复肾重复输尿管畸形九例报告

目的 探讨后腹腔镜手术治疗重复肾重复输尿管畸形的疗效.方法 回顾性分析9例重复肾重复输尿管患者的资料.男6例,女3例.年龄13～58岁,平均37岁.左侧5例,右侧2例,双侧2例(其中1例左侧输尿管3条,右侧2条).重复肾重复输尿管位于肾上极7例,下极2例.9例术前彩色多普勒超声、MRU、ⅣU或CTU检查确诊为重复肾.采用后腹腔镜下重复肾重复输尿管切除术.观察手术时间、术中出血量、术后住院天数和术中术后并发症及手术效果.结果 9例手术均获成功,术中均未发生周围脏器、血管损伤.手术时间65～125 min,平均87 min.出血量30～600 ml,平均112 ml.术后肠道功能恢复时间1～3 d,平均1.6 d;术后住院天数5～12 d,平均7 d.随访6～36个月,平均18个月0.原发病症状消失,残留半肾功能良好.结论 后腹腔镜下手术治疗重复肾重复输尿管畸形创伤小、并发症少、恢复快、疗效确切,可作为重复肾重复输尿管治疗的首选术式.

Abstract：

Objective To investigate the efficacy of retroperitoneal laparoscopic heminephroureterectomy for duplex kidney anomalies.Methods Retroperitoneoscopic heminephroureterectomy was performed on nine patients, six males and three females.The average age of the study group was 37 years ( range 13 to 58).Seven cases had anomalies on the upper kidney pole, two cases had anomalies on the lower kidney pole.Five anomalies were on the left side, two were on the right side and two were in bilateral sides (one special case had three ureters on the left side and two ureters on the right side ).Three cases complained of flank pain; two cases were found hydronephrosis by physical routine examination;Three cases complained of flank pain and fever; one cases complained of hematuria and kidney atones.All the cases were preoperatively diagnosed by color doppler ultrasound, MRU, IVP or CTU.Retroperitoneal laparoscopic heminephroureterectomy was performed on all patients.The operation time, blood loss, hospital stay, intraoperative and postoperative complications and efficacy were observed.Results All the retroperitoneal laparoscopic procedures were successfully completed.No intraoperative complications were found.The average operation time was 87 min (range, 65 to 125).The average blood loss was 112 ml (range, 30 to 600).The recovery times of intestinal function was 1.6 days ( range, 1 to 3 ).The average postoperative hospital stay was 7 days (range, 5 to 12).The syndrome disappeared and kidney function was normal at a mean followup of 18 monthes.Conclusions Retroperitoneal laparoscopic surgeries for duplex kidney has the benefits of being minimally invasive, fewer complications, quick recovery and certainty of efficacy.Retroperitoneal laparoscopic surgeries can be considered as a first operation method to treat duplex kidney anomalies.     

经脐单一部位腹腔镜急腹症探查术100例报告

目的探讨经脐单一部位腹腔镜技术在急腹症诊疗中的安全性和可行性。方法回顾性分析2011年1～9月100例以急腹症行经脐单一部位腹腔镜探查的临床资料。经脐纵行切口20mm，置人硅胶切口保护套（欣皮护）后送入腹腔镜trocar并开始注气，5mm治疗镜探查腹腔；根据不同病变，采用相应的治疗措施。结果100例中，85例为急性阑尾炎，其中76例经脐提出阑尾切除，因阑尾坏疽，局部炎症重，或腹膜后位阑尾，4例行经脐单一部位腹腔内阑尾切除；5例从耻骨上另外置入5mmtrocar完成腹腔内阑尾切除。8例胃穿孔，其中6例经脐单一部位行修补术，2例从右上腹置入5mmtrocar完成修补术。1例出血性小肠炎，经脐提出行回肠切除、空肠造瘘术。2例女性盆腔感染，经脐单一部位行盆腹腔灌洗术。1例卵巢囊肿蒂扭转，经脐单一部位行卵巢囊肿切除术。1例下腹局部肠粘连，经脐单一部位行粘连松解术。2例术中发现腹腔内有乳糜样积液，其中1例为自发性乳糜性腹膜炎，经钛夹夹闭渗漏淋巴管和腹腔冲洗后治愈，另1例为空肠系膜淋巴管瘤，中转开腹切除。术后脐部渗液3例，肠麻痹2例。术后随访6～9个月，脐部切口愈合好，隐蔽，无脐切口疝。结论应用小的硅胶切口保护套经脐单一部位腹腔镜探查安全可行，美容效果较好。     

单孔腹腔镜根治性肾切除术治疗肾细胞癌

目的探讨应用单孔腹腔镜手术(laparo endoscopic single-site surgery,LESS)行根治性肾脏切除术治疗肾脏肿瘤的临床安全性及可行性。方法 2010年11月至2011年4月,我们应用单孔4通道(Quadport)单孔腹腔镜根治性肾脏切除术技术治疗3例肾脏肿瘤,1例为右侧中央型4.2cm肾肿瘤,另两例分别为左侧肾下极7.4cm和肾中部4.5cm肾肿瘤。经脐部切口将Quadport置入腹腔,采用5mm头部可弯腹腔镜和标准腹腔镜直器械实施标准经腹腔途径腹腔镜根治性肾脏切除术。记录患者手术时间、估计术中出血量、术中并发症、留置引流管时间、术后住院时间和术后病理等临床资料,并对结果进行分析。结果本组3例手术均由LESS完成,无加辅助通道、无转标准腹腔镜手术或开放手术完成病例。仔细实施手术步骤,避免过度钝性分离组织造成术中出血是手术顺利进行的基础。采用Quadport减少了器械间的相互干扰。根治性肾脏切除术手术操作时间分别为215、230、170min,估计术中出血量分别为100、100、150ml。本组手术无术中严重并发症。术后留置引流时间分别为4、3、2d,术后住院时间分别为8、10、8d。本组术后无继发性出血和切口感染病例。病理结果示肾透明细胞癌2例,肾嫌色细胞癌1例,无淋巴结转移,病理分期分别为pT1bN0M02例,pT2aN0M01例。本组未见肿瘤侵及肾周围组织。结论 LESS根治性肾脏切除术治疗肾脏肿瘤是安全可行的,但需要更多的研究来进一步验证。     

经脐单孔腹腔镜肾切除术2例报告

目的：初步探讨经脐单孔腹腔镜肾切除术的临床可行性和安全性。方法：2009年6～7月,对2例患者行经脐入路单孔腹腔镜肾切除术,1例右肾癌患者行单孔腹腔镜右肾根治性切除术,1例左侧积水性无功能肾患者行单孔腹腔镜单纯左肾切除术。患者取45。健侧卧位,作2．5cm绕脐“Z”形皮肤小切VI,Hasson法制备经腹腔入路单孔腹腔镜工作通道切口,置入单孔三通道腹腔镜操作通道。从单孔通道分别置人5mm腹腔镜和手术器械,按照标准的腹腔镜根治性肾切除术和单纯。肾切除术的手术操作步骤完成手术,切除标本均从脐部切口取出。结果：2例手术均顺利完成,手术时间分别为210min和90min,估计出血量分别为100ml和20ml,无中转开放及标准三孔腹腔镜手术,术中无并发症发生,短期随访无术后并发症发生。结论：小样本的临床研究结果初步显示了单孔腹腔镜。肾切除术良好的安全性和可行性。然而,该术式的临床治疗效果尚需大样本中远期随访和对照研究予以证实。     

经脐单孔腹腔镜直肠癌根治术

目的:探讨用常规腹腔镜器械行单孔腹腔镜直肠癌根治术的安全性及可行性。方法:回顾分析2009年12月至2010年2月为7例患者行经脐单孔腹腔镜直肠癌根治术的临床资料,其中Dixon术3例,Hartmann手术2例,Miles术2例。结果:所有手术均获成功,无中转多孔腹腔镜手术或开腹手术,手术时间150~180min,平均167min,术中出血20~80ml,平均44ml,术后肠功能恢复时间2~3d,平均2.3d,术后住院3~6d,平均4.8d,随访3个月至今,患者生活质量好。结论:经脐单孔腹腔镜直肠癌根治术安全、可行,且疗效显著。     

经脐单孔腹腔镜腹膜外前列腺癌根治术7例报告

目的：报告经脐腹膜外单孔腹腔镜前列腺癌根治术的初步经验。方法：20110年2～11月采用经脐单孔腹腔镜腹膜外前列腺癌根治术治疗经活检确诊为前列腺癌患者7例,采用“两环一套法”自制单孔腹腔镜开口器,手术器械包括预弯抓钳、吸引器、针持。其余为传统腹腔镜器械。在脐下缘取2．5cm长弧形切口,进入腹膜外问隙,置人开口器建立单孔腹腔镜手术工作通道,再依次行双侧盆腔淋巴结清扫、前列腺癌根治术,最后采用一针连续缝合法行膀胱颈尿道吻合。记录手术时间、失血量、输血量、并发症发生情况。术后第3、6个月随访,复查血清PSA,了解尿控情况和患者对手术美容效果的满意度。结果：手术时间210～420min,平均272min;术中失血量为50～500ml,平均170ml。2例患者术中需要输浓缩红细胞2～3U,余未输血。仅1例手术需要增加2个工作通道,余患者无中转开放手术或增加工作通道,无围手术期死亡及严重并发症的发生。所有患者排尿可控,仅最后1例患者夜间需预防性使用尿垫1块。术后切口瘢痕隐匿在脐部皱褶内,患者对切口美容效果很满意。结论：在合理选择患者的前提下,采用经脐单孔腹腔镜腹膜外前列腺癌根治术是安全可行的,美容效果很好。“两环一套法”自制开口器能够保证手术顺利实施,性价比高。短期随访显示肿瘤控制及尿控效果好,远期效果需待长期随访来证实。     

增加辅助孔的经脐单孔腹腔镜巨大卵巢囊肿手术

目的探讨改良经脐单孔腹腔镜治疗巨大(>10 cm)卵巢囊肿的安全性。方法2018年6月~2019年12月,行改良经脐单孔腹腔镜巨大卵巢囊肿手术57例,经脐开放式入路,切口2~2.5 cm,置入切口保护套及单孔Port,左下腹置5 mm trocar和器械协助。行卵巢囊肿剥除18例,附件切除25例,全子宫+单/双附件切除10例,全子宫+双附件+大网膜+盆腔淋巴结切除4例(其中2例加行阑尾切除术)。结果3例因严重粘连加右下腹5 mm trocar双人配合操作,其余54例均单人操作行增加一个辅助孔的经脐单孔腹腔镜手术,无中转开腹。术后随访1~18个月,平均12.3月,1例黏液性囊腺瘤剥除术后6个月复发。结论增加辅助孔的经脐单孔腹腔镜技术治疗巨大卵巢囊肿具有良好的器械操控性,可行切口保护,可安全、快速取出标本,具有一定的临床推广价值。     

55例单切口泌尿系腹腔镜手术回顾分析

目的:总结单切口腹腔镜泌尿外科手术的手术经验与体会,探讨单切口腹腔镜手术在泌尿外科的应用价值。方法:回顾分析2009年6月至2011年10月为55例患者行单切口腹腔镜手术的临床资料,其中前列腺癌根治术10例,肾部分切除术6例,肾上腺切除术20例,肾盂成形术3例,输尿管切开取石术9例,输尿管膀胱再植术3例,肾囊肿去顶减压术4例。结果:55例手术均获成功,无一例中转开放或中转普通腹腔镜手术。手术时间68～320 min,平均(105±38)min;出血量10～120 ml,平均(60±35)ml,无输血病例;平均住院(6.1±2.4)d,术后随访1～24个月,无肾脏萎缩及肿瘤局部复发、远处转移征象。结论:单切口腹腔镜手术安全、可行,具有微创、美观等优点,但操作难度较传统腹腔镜手术增加,应谨慎把握手术适应证,术者具备扎实的普通腹腔镜操作技术方可开展。     

Experiencia inicial en prostatectomía radical laparoscópica con el dispositivo de acceso laparoscópico umbilical Single-Incision Laparoscopic Surgery Port®

Since 2007, various urological procedures have been performed with laparoendoscopic single-site surgery (LESS surgery), including nephrectomy, pyeloplasty, simple prostatectomy and, with the refinement of laparoscopic instrumentation, radical prostatectomy. This paper reports our initial experience in radical prostatectomy using the SILS? Port from Covidiem and two lateral 5-mm trocars for triangulation. The SILS? Port allows for accurate, simple insertion through a Hadson incision. The flexible port accomodates three 5-mm cannulas or two 5-mm cannulas and a 12-mm port for easier instrument exchange through a single incision. This approach decreases morbidity from bleeding, hernia and/or internal organ damage and improves cosmetic results.One-port single-incision laparoscopy is part of the natural development of minimally invasive surgery. Future research is required to assess the intraoperative and postoperative benefits of LESS surgery as compared to standard laparoscopy.     

单孔腹腔镜输尿管切开取石术的初步应用体会

目的 探讨经腹膜后途径,行单孔腹腔镜输尿管切开取石术的可行性及疗效.方法 2010年6月至2011年2月,收治8例单侧输尿管上段结石患者,采用自制多通道套管,经腹膜后途经,行单孔腹腔镜输尿管切开取石术.以同一术者完成的15例传统腹腔镜经腹膜后输尿管切开取石术作为对照组.对比两组的手术时间、出血量、手术并发症、平均住院时间、术后镇痛药应用时间及腹膜后引流管停留时间等指标.结果 所有单孔腹腔镜手术均获成功、无1例转为传统腹腔镜或开放术式.结石平均长径18 mm,平均手术时间131±16min,失血量30±5 ml,1例术后出现尿漏、于术后第3天停止;无其他手术并发症.两组手术时间、出血量、腹膜后引流管停留时间等无明显差异.单孔腹腔镜组在平均住院时间、术后镇痛药应用天数及美容效果等方面优于传统腹腔镜组.两组患者均获得治愈.结论 单孔腹腔镜输尿管切开取石术是可行、有效的,适用于治疗部份体积较大的输尿管结石病例,其远期效果有待增加病例数进一步评估.     

针钩辅助的经脐单孔腹腔镜阑尾切除术

目的:探讨应用自制的针式拉钩辅助施行经脐单孔腹腔镜阑尾切除术的可行性与优点。方法:将克氏针弯曲成钩状,穿入腹腔,辅助施行12例经脐单孔腹腔镜阑尾切除术,回顾分析其临床资料。结果:12例手术均获成功。手术时间30~120min,平均(75±32)min,术中出血3~10m l,平均(5±5)m l。无并发症发生。术后24h胃肠功能恢复并进食。住院时间3~5d,平均4.5d,术后2周复查腹部无明显瘢痕。结论:应用针钩辅助经脐单孔腹腔镜阑尾切除术安全、可行,且更方便快捷,美容效果好。