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。

Single Port Transumbilical Laparoscopic Nephrectomy(Report of 2 Cases)

Objective： To investigate the clinical safety and feasibility of single port transumbilical nephrectomy. Methods： From June 2009 to July 2009, two cases of single port transumbilieal laparoscopic nephrectomy were performed by one surgical team, including a case of single port laparoscopic radical nephrectomy for right renal cell cancer, and another case of single port laparoscopic simple nephrectomy for nonfunctioning left hydronephrotic kidney, respectively. The patient was placed in a 45°flank position for transperitoneal surgery. A 2.5 cm·Z type skin incision around umbilicus was made and deepened to the anterior rectus fascia, where a 2.5 cm fascial incision was made, the peritoneum was incised, and the TriPort was deployed. A 5-mm rigid video-laparoscope and two laparoscopic instruments were inserted through the access port inlets. Then, standard procedures of laparoscopic radical and simple nephreetomy were performed in those two cases. Finally, specimen was removed through the skin incision around umbilicus. Results： Two cases of single port transumbilical laparoscopic nephrectomy were per formed successfully. The operating time was 210 rain for single port laparoscopic radical nephrectomy and 90 rain for simple nephrectomy, and the estimated blood loss is 100ml and 20ml, respectively. No conversion to open or 3-port laparoscopic surgery was necessary. No intra-operative complications was observed, nor was post-operative complications after a short term follow up. Conclusions：Initial study on single port transumbilical laparoscopic ne phrectomy has shown its clinical safety and feasibility. However, those results should be proved by further largescale control study and long-term follow up.