单曲卡单孔腹腔镜手术在泌尿外科的应用

目的 初步总结单曲卡单孔腹腔镜手术在泌尿外科应用的体会。方法 2010年4-12月,施行单曲卡下的单孔腹腔镜手术45例。分别为腹腔镜下精索静脉高位结扎术17例,后腹腔镜下肾囊肿去顶减压术24例、输尿管切开取石术4例。腹腔镜手术组,在脐孔做15 mm切口,建立CO2气腹,穿刺入10 mm曲卡,置入整合工作通道的单通道腹腔镜,经上述工作通道放入操作器械,完成精索静脉高位结扎术。后腹腔镜手术组,在患侧髂嵴上3指做15 mm切口,IUPU法(Institute of Urology,Peking University的首字母缩写)建立后腹腔,同样方法穿刺入10 mm曲卡,置入整合工作通道的单通道腹腔镜,经工作通道放入操作器械,完成肾囊肿去顶减压术、输尿管切开取石术。结果 两组45例患者,完成41例单曲卡下的腹腔镜手术,2例肾囊肿及2例输尿管结石,再增加一枚5 mm曲卡后完成手术。手术时间：腹腔镜组23～70 min;后腹腔镜组45～175 min。术中出血少,术后住院1～5d。两组术后均无明显并发症。结论 对于一些比较简单的腹腔镜手术,完全可以施行一种全新的、更微创的单曲卡单孔腹腔镜手术来完成。

Single trocar laparoscopic surgery: a report of 45 cases

ObjectiveTo report the initial urological applications of single trocar laparoscopic surgery. MethodsFrom April to December 2010, a total of 45 urologic patients underwent single trocar laparoscopic surgery. The procedures included high ligations of spermatics vessels (n = 17 ), unroofing of renal cysts (n =24) and ureterolithotomy (n =4). Transperitoneal approach: A 15 mm incision was made in umbilicus and CO2 pneumoperitoneum created. A 10-mm trocar was inserted into enterocoelia. After the installation of single punch laparoscope (STROZ), the operating instruments were guided through integrated working channel to complete operative procedures.Retroperitoneal approach: A 15 mm incision was made above thediseased-sidecristailiacafor around4cm.Retroperitonealcavitywaspreparedfor retroperitoneoscopy with the IUPU (Institute of Urology, Peking University) technique. In the same way, a 10-mm trocar wasinserted.And the single punch laparoscope was installed to complete operative procedures. ResultsThe procedures were successful in 41 cases.But the others ( renal cysts, n = 2 ;ureteral calculus,n = 2 )were successfully managed by adding a 5mm trocar.Operation time:transperitoneal approach, 23 -70 min; retroperitoneal approach, 45 -175 min. The intra-operative volume of blood loss was minimal. And the hospital stay was 1 - 5 days. No significant postoperative complication occurred. ConclusionFor some relatively simple procedures, a new and more minimally invasive approach of single trocar laparoscopic surgery may be attempted.