经脐单孔腹腔镜肾输尿管全长切除术8例分析

目的观察经脐单孔腹腔镜肾输尿管全长切除术治疗肾盂癌或输尿管癌的安全性及可行性。方法回顾性分析2011年4～10月在本院入住的肾盂癌或输尿管癌行经脐单孔腹腔镜肾输尿管全长切除术8例患者的临床资料。术中先行经尿道电切法分离壁内段输尿管。后采用脐周患侧弧形切口,用自制＂两环一套法＂建立单孔腹腔镜通道,行经脐单孔腹腔镜肾输尿管全长切除术。结果全部手术顺利,手术平均时间（179±18）min,单孔腹腔镜部分平均手术时间（146±17）min,术中平均出血量为（80±51）mL。全部患者术中未输血、无术中并发症发生、无中转开放手术。患者术后72h内排气。3～5d拔除引流管。术后1周拔除导尿管。术后住院天数为8～11d。随访3～9月,均未见肿瘤复发和转移。结论经脐单孔腹腔镜肾输尿管全长切除术安全可行,美容效果比传统腹腔镜更好。自制＂两环一套法＂建立单孔腹腔镜通道制作简单,操作方便,成本低,能够完成单孔腹腔镜肾输尿管全长切除术。

Analysis of 8 cases undergone laparoendoscopic single-site surgery for nephroureterectomy

Objective To observe the safety and feasibility of laparoendoscopic single-site surgery（LESS） for nephroureterectomy.Methods From Apr.to Oct.in 2011,8 patients with renal pelvis cancer or ureteral carcinoma received nephroureterectomy under LESS in our hospital,and the results were retrospectively analyzed.All cases underwent bladder cuff excision with resectoscope first,and then LESS radical nephroureterectomy with a single multi-channel port made of two elastic rings and one glove.Results All operations were performed successfully.The mean operation time and the mean time of LESS procedure was（178±56）min and（146±48）min respectively.The estimated intraoperative blood loss was（80±75） mL and no patient received blood transfusion.No complications were observed during the operation and no case was converted to an open surgery.All patients passed flatus 72 h after the operation.The drainage tube was removed 3~5 days after the operation.The urinary catheter was removed a week after surgery.Hospital stay was 8~11 days after the operation.During the follow-up of 3~9 months,no recurrence or metastasis was detected.Conclusion Nephroureterectomy under LESS is safe and feasible,and its cosmetic effect is better than the traditional laparoscopic surgery.The single multi-channel port made of two elastic rings and one glove is simple,economical and effective for LESS nephroureterectomy.