自制单孔多通道套管腹腔镜技术在泌尿外科的应用

目的探讨泌尿外科应用自制单孔多通道套管腹腔镜技术的临床效果。方法应用自制单孔多通道套管建立操作通道,使用常规腹腔镜及预弯器械,完成24例单孔腹腔镜手术,其中包括精索静脉结扎术9例,肾囊肿去顶术6例,输尿管切开取石术5例,无功能肾切除术2例及肾癌根治术2例。结果本组患者均经单孔腹腔镜手术完成,术中、术后无严重并发症发生。结论自制单孔多通道套管腹腔镜技术安全、可行、成本低,为进一步减少手术创伤开辟了新途径。     

单孔多通道腹腔镜在肾脏手术中初步应用的体会

目的探讨单孔多通道腹腔镜在肾脏手术种的应用价值,评估其有效性、安全性、实用性。方法 22例患者接受经腹膜后入路单孔多通道腹腔镜手术,其中包括无功能肾切除术10例,肾囊肿去顶减压术12例。结果所有手术均在单孔腹腔镜下完成,无中转标准腹腔镜或开放手术,术中及术后无并发症发生;2组平均手术时间、平均估计出血量、平均术后拔管时间、平均术后住院时间差异均有统计学意义(P<0.05)。结论经腹膜后入路单孔多通道腹腔镜手术安全可靠,具有临床应用价值和推广价值。     

尿道途径辅助下经脐单孔腹腔镜根治性全膀胱切除术

目的 :评价经尿道途径辅助下经脐单孔腹腔镜根治性全膀胱切除术的可行性及其优势。方法 :2014年10~12月,2例男性膀胱癌患者采用多通道套管,在经尿道途径辅助下,行经脐单孔腹腔镜根治性全膀胱切除、双侧盆腔淋巴结清扫及单乳头双输尿管一侧腹壁造口术。操作全部在单孔腹腔镜下进行。收集围手术期及术后资料进行分析。结果:2例手术均顺利完成,无中转常规腹腔镜或开放手术。单孔平均手术时间为4.15 h。术中平均出血量为150 ml,平均术后住院时间为15 d。围手术期内无严重并发症发生。术后病理示2例手术标本切缘均为阴性,平均清扫淋巴结16.5个,前者3/15阳性,后者0/18阳性。结论:经尿道辅助的经脐单孔腹腔镜行全膀胱根治性切除术安全可行。该术式减少了腹腔镜与操作器械之间的相互干扰,降低了手术难度和风险,手术并发症发生率低。     

经麦氏点单孔腹腔镜辅助阑尾切除术56例临床分析

目的探讨经麦氏点腹腔镜辅助阑尾切除术手术方法及临床疗效。方法回顾分析2010年2月至2012年9月56例经麦氏点单孔腹腔镜辅助阑尾切除术患者的临床资料。结果 52例单孔腹腔镜手术获得成功,3例改行三孔腹腔镜阑尾切除术,1例直接延长麦氏点切口中转开腹。手术时间平均(35±8.8)min。术后常规抗感染治疗,1例发生切口感染。患者均治愈出院,平均住院天数(4.2±0.9)d。56例患者获得随访,无其他并发症发生,对术后疼痛感、康复情况、美容效果满意。结论经麦氏点单孔腹腔镜辅助阑尾切除术具有较好的临床效果,患者创伤小、痛苦少、康复快、美容效果满意等优点,适合年轻医师及基层医院推广应用。     

钩针辅助法经脐单孔双trocar腹腔镜阑尾切除术

目的:探讨钩针辅助法经脐单孔双trocar腹腔镜阑尾切除术可行性、安全性、微创性和美容效果。方法:对58例成年阑尾炎患者行腹腔镜阑尾切除术(LA)。在脐孔切口1.5 cm应用10mm30°腹腔镜,另外置入1枚5 mm trocar完成腹腔镜下阑尾切除手术。利用钩针(腹腔镜疝修补用)经腹壁悬吊配合完成全腹腔内操作经脐单孔双trocar腹腔镜阑尾切除术(TUSPLA)。结果:45例手术获成功,6例改为二孔法完成,4例改为三孔法,3例中转开放手术。45例经脐单孔法手术时间25~78 min,平均43 min。脐部疤痕不明显,58例术后随访5~14个月,全组无术后出血、腹腔脓肿、肠瘘和无粘连性肠梗阻等并发症。结论:钩针辅助法经脐单孔腹腔镜阑尾切除术安全可行、并发症少、恢复快,美容效果较好。     

3D单孔腹腔镜在泌尿外科手术中应用的单中心研究

目的 报道单中心开展的20例3D单孔腹腔镜手术,探讨该手术的可行性和安全性,总结操作经验,并评价其临床应用特点和价值。方法 收集2013年8月至2014年11月长海医院泌尿外科完成的20例3D单孔腹腔镜手术患者的临床资料和围手术期数据。20例患者中男性9例,女性11例。年龄31岁至69岁,平均55.8岁,平均体质指数24.64kg/m²。其中经腹腔入路14例,经腹膜后入路6例。9例肾上腺切除术,5例肾癌根治术,4例无功能肾切除术,1例肾部分切除术,1例腹膜后囊肿切除术。分析患者围手术期情况,手术时间、出血量、手术并发症和手术中转情况。结果 20例患者均在不增加任何额外切口的情况下顺利完成手术,无中转开放。在3D单孔腹腔镜下共完成5种类型手术,其中有肾上腺切除术、肾癌根治术和无功能肾切除术分别进行经腹腔镜入路和经腹膜后入路进行。本组20例3D单孔腹腔镜手术均未出现外科并发症。20例手术平均时间为156.3±56.1min,患者术后(4.5±1.6)d出院。术后第3天,15例患者疼痛评分为0分,3例为1分,2例为2分。结论 初步经验表明: 3D单孔腹腔镜下手术安全、可行、有效。3D腹腔镜由于手术图像立体感强,手术操作精确度高,手眼协调难度明显降低,能降低单孔腹腔镜手术操作的难度,具有良好的临床应用前景。目前3D单孔腹腔镜完成的手术例数较少,其长期临床疗效尚需前瞻性大样本多中心临床随机对照研究进一步证实。     

完全经脐单孔腹腔镜胆囊切除术55例临床分析

目的：探讨完全经脐单孔腹腔镜胆囊切除术的疗效及应用价值。方法：回顾性分析本院55例完全经脐单孔腹腔镜切除术患者的临床资料。结果：46例手术成功,6例中转传统三孔腹腔镜,3例中转开腹胆囊切除术,手术时间为40~160 min,平均46.4 min。术后无出血、胆汁漏等并发症发生,患者恢复良好,治疗及美容效果满意。结论：经脐单孔腹腔镜切除术安全可行,但手术难度大于LC术,必须在熟练掌握传统LC的基础上进行,注意适应证的选择,其微创和美容效果明显优于传统LC,可达到腹部无可见瘢痕的效果,具有临床推广价值。     

Minilap在腹腔镜下胆囊切除术中的临床应用研究

目的 探讨Minilap在腹腔镜下胆囊切除术中应用的可行性.方法 随机选取胆囊结石、胆囊息肉患者80例,按照随机自愿的原则分为4组(单孔腹腔镜组,Minilap辅助下单孔腹腔镜组,三孔腹腔镜组,Minilap辅助下三孔腹腔镜组)手术治疗.分别观察记录1、2组及3、4组患者的手术时间、术中出血量、术后住院时间、术后疼痛程度、术后切口满意度并分别进行对比分析.以探讨施行Minilap辅助下腹腔镜下胆囊切除术的可行性.结果 80例腹腔镜手术均获成功,无中转开腹,术后无胆漏等并发症;单孔组与Minilap辅助单孔组相比,二者在手术时间、术中出血量方面差异有统计学意义(P<0.05),二者在术后住院时间、疼痛评分、瘢痕满意度评分、使用镇痛药物方面差异均无统计学意义;三孔组与Minilap辅助三孔组相比,二者在疼痛评分、瘢痕满意度评分、使用镇痛药物方面差异有统计学意义(P<0.05),二者在手术时间、术中出血量、术后住院时间方面差异均无统计学意义;术后随访10~18个月,患者术后恢复良好,Minilap穿刺点无明显疤痕,患者对切口满意度高,美容效果好.结论 Minilap辅助下单孔腹腔镜胆囊切除术安全可行、术后美容效果好,降低了手术难度,Minilap辅助三孔腹腔镜胆囊切除术降低了术后疼痛程度、提高了患者对术后瘢痕的满意度,Minilap在腹腔镜胆囊切除术中应用可行性高,优势明显,值得临床应用.     

常规器械行经脐单孔腹腔镜左肾上腺切除术1例

目的探讨应用常规腹腔镜手术器械行经脐单孔腹腔镜肾上腺切除术的临床可行性和适应证。方法对1例左肾上腺肿瘤患者应用常规腹腔镜器械行经脐入路单孔腹腔镜单纯左肾上腺切除术。患者取右侧卧位,作环脐2 cm皮肤小切口,Hasson法制备经脐入路单孔腹腔镜工作通道,应用常规腹腔镜手术器械,按标准经腹肾上腺切除术操作步骤完成手术,切除标本从脐部切口取出。结果手术顺利完成,无中转开放及转为标准三孔腹腔镜手术,未留置引流管,无术中并发症发生,随访4周无术后并发症发生。结论临床结果显示了应用常规腹腔镜器械行经脐单孔腹腔镜左肾上腺切除术良好的安全性和可行性,有望成为左侧肾上腺切除术新的金标准。     

妇科腹腔镜手术严重并发症探讨

目的：对妇科腹腔镜手术严重并发症发生情况进行分析。方法本组研究对象为726例妇科腹腔镜手术患者,对其并发症发生情况进行分析。结果726例行妇科腹腔镜手术患者9例出现严重并发症,其中出血性并发症5例,损伤性并发症4例;腹腔镜辅助阴式子宫切除术并发症发生率最高,腹腔镜全子宫切除术中转开腹率最高。结论妇科腹腔镜手术可造成严重并发症,临床医师应严格掌握妇科腹腔镜手术适应证,不断提升自身手术技能,对手术器械予以改善,适时转为开腹手术,从而控制严重并发症发生率。     

Synchronous bilateral laparoendoscopic single-site urological surgeries via the umbilicus: a report of 2 cases

Objective:To describe two cases of bilateral transumbilical laparoendoscopic single-site(LESS) surgeries in a single operative session and assess the safety,feasibility and efficacy.Methods:One patient underwent right ureterolithotomy and left varicocelectomy,and the patient was performed with right simple nephrectomy for nonfunctioning kidney due to ureteral calculus and left ureterolithotomy using a novel multichannel TriPortTM via a single 2-3 cm transumbilical incision.Results:The right-side ureterolithotomy and left-side varicocelectomy were finished in 229 minutes,with a total estimated blood loss of 50 ml.The right-side simple nephrectomy and left-side ureterolithotomy in the other patient were finished in 340 minutes,with a total estimated blood loss of 100 ml.There were no major complications.At the latest follow-up,both patients remained symptom-free and there were no evidences of recurrence.Both of them were delighted for the single scar.Conclusion:Synchronous LESS urologic procedure via a single umbilical incision is technically feasible,safe and efficacious with a promising potential.     

Transumbilical laparoendoscopic single-site surgery of simple nephrectomy of nonfunctioning kidney: a two-year experience

Background

Laparoendoscopic single-site surgery (LESS) may serve as a potential alternative to conventional laparoscopy and is developing quickly, but still in its infancy. The study is to present our two-year experience in transumbilical LESS simple nephrectomy (LESS-SN) for non-functioning kidney, in an effort to evaluate its feasibility, clinical outcomes and potential advantages.

Methods

From December 2008 to December 2010, a total of 11 patients with body mass index (BMI) ≤30 underwent transumbilical TriPort™ LESS-SN by a single experienced urologist at our institution. The indications for nephrectomy included nonfunctioning kidney associated with ureteropelvic junction stricture (n=1), ureteral calculi (n=6), tuberculosis (n=3), and ureteral stricture (n=1). Patient demographics, perioperative and follow-up data were prospectively collected and analyzed.

Results

Ten procedures were successfully completed with one patient converted to open surgery due to uncontrollable bleeding. The mean operative time was 189.2 (ranging 100∼320 min) with an estimated blood loss of 204.5 (ranging 501 000 ml). There were two complications of bleeding (1 intra-, 1 post-). The mean hospitalization after surgery was 7.9 d (ranging 417 d). With a regular follow-up of 1, 6, 12, and 24 months after surgery, all patients remained symptom-free with an intra-umbilical scar.

Conclusion

Transumbilical LESS simple nephrectomy for nonfunctioning kidney can be accomplished with favorable surgical outcomes and a superiority of cosmesis. However, cases with chronic inflammation are not suitable for initial up-take and should only be attempted by the very experienced laparoscopist.     

腹膜后腹腔镜手术在泌尿外科中的应用

目的探讨腹膜后腹腔镜手术在泌尿外科中的应用。方法 2006年7月~2010年12月我院共进行泌尿外科腹腔镜手术53例,其中肾上腺肿瘤切除3例,肾切除3例,肾囊肿去顶减压35例,输尿管切开取石术12例。结果 53例手术均成功。手术时间肾上腺肿瘤切除80~160min（平均110min）,肾切除术110~190min（平均130min）,肾囊肿去顶减压术40~100min（平均70min）,输尿管切开取石术70~170min（平均100min）。术中出血20~260ml（平均80ml）。术后住院6~12d,平均8d。结论腹膜后腹腔镜手术具备切口小、损伤小、出血少、住院时间短等优点,适合泌尿外科开展。     

后腹腔镜技术治疗泌尿外科疾病的体会

目的观察后腹腔镜技术治疗泌尿系疾病的方法及临床效果.方法采用后腹腔镜技术治疗泌尿系疾病61例,其中肾上腺肿瘤切除术7例,肾囊肿去顶术11例,肾切除术10例,肾、输尿管、膀胱开口袖状切除术3例,根治性肾切除术7例,离断式肾盂成形术3例,肾盂切开取石术4例,输尿管切开取石术16例.结果61例中的59例手术获得成功.手术时间30～180min,平均106.0min;术中平均出血57.9ml,术中及术后均未输血,无明显并发症;术后住院时间2～11d,平均6.5d.结论腔镜手术治疗泌尿系疾病,具有安全,有效,损伤小,住院时间短,恢复快,并发症少,疤痕少等优点,在泌尿外科具有很好的应用前景,但须掌握适应症.     

Application in robotic urologic surgery

BackgroundThe da Vinci robot system has become the mainstay of minimally invasive surgery and has been used in numerous complex reconstructive procedures. Due to the success of this innovative technology, we attempted to expand our practical model and application of the da Vinci robot system into other urologic surgeries, beginning with robotic-assisted laparoscopic radical prostatectomy (RALRP).MethodsWe retrospectively reviewed a total of 683 patients who underwent robotic-assisted urologic surgery between December 2005 and December 2012. We divided this 8-year course of device use into three periods, and analyzed the surgical capability of operations in 1 day over different periods through a retrospective analysis.ResultsIn the first period (2005–2008), 159 cases of robotic-assisted urologic surgeries were performed. A total of 195 cases were performed in the second group (2009–2010), and 329 cases in the third (2011–2012). Starting with radical prostatectomy in December 2005, we performed various types of procedures such as partial nephrectomy, pyeloplasty, nephroureterectomy with cystoprostatectomy, nephroureterectomy with bladder cuff, radical cystoprostatectomy/cystectomy with ileal conduit reconstruction, partial cystectomy, adrenalectomy, nephropexy, simple prostatectomy, ureteral reconstruction, and pyelolithotomy/ureterolithotomy. The mean operation times of prostatectomy, partial nephrectomy, nephroureterectomy with radical cystectomy/cystectoprostatectomy, and nephroureterectomy were 154, 140, 295, and 129 minutes, respectively.ConclusionBased on our experience, a robotic system can be applied to many different types of urologic surgeries both safely and efficiently.     

手助腹腔镜肾脏手术临床分析

目的 探讨手助腹腔镜肾脏手术的方法和临床应用价值。方法 从2001年8月至2003年11月,我们对45例泌尿外科患者施行手助腹腔镜肾脏手术。其中根治性肾切除术23例,单纯性肾切除术9例,肾输尿管全长切除膀胱袖套状切除术8例,肾囊肿切除术3例,部分性肾切除术1例,重复肾副肾切除术1例。其中有7例是经腹膜后途径完成,其余均为经腹腔途径。结果 45例手助腹腔镜肾脏手术均获成功。手术时间40～300min,平均154．7min;术中出血15～300ml,平均100.4ml。结论 手助腹腔镜肾脏手术具有损伤小,出血少,术后恢复快等优点,值得临床推广应用。     

Transumbilical laparoendoscopic single-site surgery（LESS） partial nephrectomy： a median follow-up of 2 years

Objective:Nephron-sparing surgery (NSS) for small renal masses offers a similar functional and oncological outcome to that of radical surgery.Laparoendoscopic single-site surgery(LESS) emerges as an advanced alternative for reduced invasiveness and improves cosmesis; LESS is developing quickly and its indications have been expanded,but still in its infancy.The aim of this paper is to report our preliminary experience in transumbilical LESS partial nephrectomy (LESS-PN),so as to assess its utility,safety and efficacy.Methods:From August 2009 to October 2010,3 patients underwent transumbilical LESS-PN via a novel multi-channel TriPort by a single experienced urologist in our institution.Patient demographics,perioperative and follow-up data were prospectively collected and analyzed.Results:All the three procedures were successfully completed.A 5-mm ancillary trocar was utilized in all 3 cases. The mean operative duration was 226.3 (210-254 min) with an estimated blood loss of 56.7 ml (20-100 ml).Mean warm ischemia time was 35.7 min (19-48 min). One patient was transfused due to postoperative bleeding.The recovery was uneventful and mean length of postoperative stay was 13 days (12-14 days).At the latest follow-up,all patients remained symptom-free and had normal renal function without evidence of recurrence,and they were delighted for a hidden transumbilical scar.Conclusion:Transumbilical LESS-PN is a feasible and safe procedure albeit extremely technically challenging.Surgical outcomes at a median follow-up of 2 years are promising,while currently it should be reserved for highly selected patients with favorable tumor anatomy and performed by a very experienced laparoscopic surgeon.     

经脐单孔多通道腹腔镜肾癌根治术与标准腹腔镜肾癌根治术临床疗效对比研究

目的通过与标准经腹腹腔镜肾癌根治术进行对照研究,评价经脐单孔多通道腹腔镜肾癌根治术的临床疗效。方法 2008年9月至2011年1月,本单位同一手术组共完成经腹腹腔镜肾癌根治术105例,其中经脐单孔腹腔镜肾癌根治术21例,标准经腹腹腔镜肾癌根治术84例。回顾性分析和比较21例单孔腹腔镜肾癌根治术(A组,2009年9月至2011年1月)和21例标准经腹腹腔镜肾癌根治术(B组,2008年9月至2010年3月)的临床资料和随访信息。两组的配比因素为:患者年龄、体质指数、肿瘤最大径及位置、手术适应证(T1期)。结果 A、B两组的术后疼痛评分分别为3.5±0.84和4.1±1.06,术后肠道功能恢复时间分别为(31.6±17.98)、(42.3±19.94)h,手术切口满意度评分分别为8.2±0.71和7.3±0.85,差异均有统计学意义(P<0.05)。两组的前10例手术时间差异有统计学意义(P=0.030),但后10例(P=0.495)及总体(P=0.076)手术时间差异均无统计学意义。术后随访时间分别为(8.4±4.41)和(20.0±3.95)个月(P=0.000),两组患者均未出现肿瘤复发或转移。结论与标准经腹腹腔镜肾癌根治术相比,经脐单孔多通道腹腔镜手术患者术后疼痛轻,肠道功能恢复快,切口满意度高,但肿瘤治疗效果仍需进一步长期随访予以证实。     

肾细胞癌治疗单中心临床分析(1995-2009年)

目的总结分析我院15年的肾细胞癌临床数据,探讨技术的引进与改良对肾细胞癌外科治疗的微创率、手术切除率及安全性的影响。方法回顾性分析我院自1995年1月至2009年11月收治的2 052例肾癌病例,按时间顺序分为3组:1995年1月至1999年12月为第1组,2000年1月至2004年12月为第2组,2005年1月至2009年11月为第3组。比较各组的手术方式、手术切除率及安全性。结果 2 052例肾癌病例中,T1期1 516例;T2期以上536例,其中复杂性肾癌(伴淋巴结转移、静脉癌栓、侵犯周围脏器但可切除、肝肺孤立转移)277例,完成根治手术217例、姑息性手术41例、未完成手术19例(包括术中因癌栓脱落死亡3例)。第1组共546例,全部采用开放手术,其中保留肾单位手术42例;复杂性肾癌89例,完成根治手术64例、姑息性手术16例、未完成手术9例(包括术中因癌栓脱落死亡2例)。第2组共673例,采用腹腔镜手术(经腰)117例;开放手术556例,其中保留肾单位手术95例;复杂性肾癌88例,完成根治手术68例、姑息性手术13例、未完成手术7例(包括术中因癌栓脱落死亡1例)。第3组共833例,采用腹腔镜手术585例;开放手术248例,其中保留肾单位手术142例;复杂性肾癌100例,完成根治手术85例、姑息性手术12例、未完成手术3例,无围手术期死亡病例。结论腹腔镜技术的进步使肾细胞癌的手术治疗从开放手术转向微创,微创手术逐渐成为主流手术方式。手术操作技术的改进,使复杂性肾癌的安全性与切除率提高,保留肾单位手术应用越来越多,并逐渐向微创手术方向发展,单孔腹腔镜手术在肾癌外科治疗领域越来越受到重视。