单切口经腹腔内途径腹腔镜下肾上腺肿瘤切除术（附10例报告）

目的：介绍单切口经腹腔内途径腹腔镜下。肾上腺肿瘤切除术的初步经验、可行性、操作难点，评价该技术在肾上腺肿瘤外科治疗中的应用前景。方法：2009年7月～2009年9月，我科采用经腹腔内途径单切口腹腔镜技术，对10例肾上腺肿瘤患者行切除术。统计数据包括年龄、性别、肿瘤大小、位置以及手术时间、术中估计出血量、术中术后并发症。自制3通道连接装置并通过长约2．5～3cm皮肤切口与腹腔内联通，手术过程中分别使用CambridgeEndo头端可弯腹腔镜器械、超声刀技术、Hem—o-lok等。结果：10例手术均取得成功，无一例增加切口辅助操作或中转开放。手术时间平均110．5min（62～148min），术中平均出血36ml（10～60ml），术后1天拔除胃管、导尿管，术后3天拔除腹腔引流管，术后住院时间4～6天。全部患者术中、术后均未出现血压明显波动、大出血、伤口感染等并发症。结论：单切口经腹膜内途径腹腔镜下肾上腺肿瘤切除术可行性强、安全性高；但操作难度大、学习曲线较长。因此手术器械及操作技术的不断改进有助于单切口腹腔镜在泌尿外科微创领域更为广阔的发展。

Single Incision Peritoneal Laparoscopic Adrenalectomy (Report of 10 Cases)

Objective：To present our initial with single incision laparoscopic adrenalectomy（SILA） , clinical feasibility and the difficulty of operate. A prospective study was performed to evaluate patient outcomes after SI- LA. Methods：Between July 2009 and September 2009, we have performed single incision peritoneal laparoscopic adrenalectomy in 10 patients for adrenal tumors. Data were collected prospectively into our institutional review board-approved data registry, including Age, Sex, Tumor size, location and Operating time, Mean estimated blood lose, Intraoperative and Postoperative complications. A multichannel port was inserted transperitoneally through a 2.5 cm-3 cm incision which was made by our institution. The instruments of Cambridge Endo, ultrasound knife,Hem-o-lok were used during the operation. Results： All cases were completed successfully, without conversion to an open surgery and extra trocar for assistance. The total operative time ranged from （62-148） min, mean time was 110. 5 min. The mean perioperative blood loss was 36ml, range from （10-60）ml, indwelling gastric canal and ureteral catheter 1 day, drainage tube 3 days, postoperative hospital stay 4-6 days. No perioperative or postoperative complications occurred, such as blood pressure fluctuation, hemorrhea and incision infection. Conclusions：Single incision peritoneal laparoscopic adrenalectomy is high feasible and safety but the operation is difficult, a longer learning curve. Therefore, the continue to improve of surgical instruments and operating techniques will help the development of single-incision minimally invasive laparoscopy in urology.