3D腹腔镜技术在肾脏疾病手术中的应用

目的:探讨3D腹腔镜技术在泌尿外科肾脏疾病手术中的应用。方法:我院于2013年3~10月完成3D腹腔镜肾脏手术52例,其中肾癌根治性术20例,肾部分切除术16例,单纯肾切除术12例,肾输尿管全切术4例。所有患者术前均行B超、IVU、CT或MRI检查,检测对侧肾功能正常,肾脏良性病变提示患肾无功能,肾脏恶性病变选择T1~T2N0M0的患者,肿瘤局限于肾包膜内,肾门及周围淋巴结无肿大,观察手术时间、术中出血量及手术效果。结果:52例手术全部获得成功,手术时间50~130min,其中肾癌根治术70~110min;肾部分切除术65~100min;肾蒂阻断时间14~25min,平均16.2min;单纯肾切除术50~90min;肾输尿管全切术60~130min;术中估计出血量为60~350ml,术中术后均未输血,术后住院5~9d,平均6d。术后病理提示肾母细胞瘤1例,乳头状肾细胞癌1例,肾错构瘤6例,肾透明细胞癌28例,输尿管尿路上皮癌4例,肾结核2例,肾萎缩样改变10例。以上所有患者切缘均为阴性,未见转移灶。术后随访1~7个月,无肿瘤复发及切口种植转移。结论:3D腹腔镜技术是传统腹腔镜技术的一大进步,降低了手术难度,缩短了手术时间。该系统具备腹腔镜与开放手术共同的优势,手术解剖更加精确,缝合操作相对容易,值得临床推广。

Application of 3Dlaparoscopic in kidney disease surgery

Objective：To preliminary explore the 3Dlaparoscopic techniques in the application of surgical treatment in kidney disease.Method：From Mar.2013to Oct.2013,a total of 52cases of laparoscopic surgery were completed by using 3Dlaparoscopy system.Those included 20cases of radical nephrectomy,16cases of partial nephrectomy,12cases of simple nephrectomy,4cases of nephro-ureterectomy.B-ultrasound,IVU,CT or MRI were performed before operation in all 52cases;and renal function were within the normal range,ipsilateral kidney had non-function.Malignant renal neoplasm were all T1-T2N0M0.Result：All operations were successful and effective.The operation time of 50-130min,with the time of radical nephrectomy of 60-110min,partial nephrectomy of 65-100min,simple nephrectomy of 50-90min,nephro-ureterectomy of 60-130min,the time of renal pedicle clamping of partial nephrectomy surgery was 14-25min,an average of 16.2min,the blood volume was 60-350ml.And the postoperative hospital time was 5-9dwith an average of 6d.Pathological diagnosis showed nephroblastoma in 1patient,papillary carcinoma in 1,angioleiomyolipoma in 6,clear cell carcinoma in 28,ureter urothelial carcinoma in 4,nephrotuberculosis in 2,atrophic kidney in 10.All patients did not receive blood transfusion and had no obvious complication.With the follow-up of 1-7months,we have not found any local relapse and tumor seeding of the incision site.Conclusion：3Dlaparoscopic technology can provide anatomical layering similar to open surgery.Anatomy is more accurate and the suture is relatively easy compared with traditional laparoscopic.The system has the advantages of both laparoscopic and open surgery,and will have a good prospect in the urologic clinical practice.