摘要
目的探讨应用单孔腹腔镜手术（LESS）在泌碌外科老年肿瘤性切除中应用的安全性及可行。方法2010年8月至2011年3月我们应用德国奥林巴斯公司生产四端口开关元件（Qurldport） LESS进行前列腺癌根治术5例，根治性肾切除术3例，肾上腺切除术4例。其中前列腺癌根治术和肾癌根治术均经脐部切口，肾上腺切除采用患侧12肋下腋中线横行切口。Quadport置入腹腔或腹膜外腔隙，采用5mm头部可弯腹腔镜和标准血腹腔镜器械实施下术。记录患者手术时间、估计术中出血量、术中并发症、术后疼痛评分（VAPS）、留置引流管时间、术后佳院时间和术后病理等临床资料，并对结果进行分析。结果本组12例手术均由LESS完成，无加辅助通道、无转标准腹腔镜手术或开放手术完成病例。仔细实施手术步骤，避免过度钝性分离组织造成术中出血是手术顺利进行的基础。采用Quadport减少了器械间的相互干扰。半均手术时间（192．0±76．7）min，术中出血量（174．6±167．2）ml。本组手术无输血，无术中严重并发症。术后VAPS（0．9±1．0）分，留置引流时间（3．5±1．7）d，术后住院时间（7．9±3．4）d。本组术后无继发性出血和切口感染病例。本组标本外科切缘均阴性。结论LESS技术治疗老年泌尿外科肿瘤安全可行，但需要业多的研究来进一步验证。
Objective To verify the clinical safely and feasibility of applying Iaparoendoscopic single site surgery （LESS） in the treatment of efder patients with urological tumors. Methods From August 2010 to March 2011, LESS technique was used to do prostatectomy in five cases nephrectomy in 3 cases and adrenalectomy in four cases. Quadport was inserted throug a transumbilical incision. Flexible tip 5 mm laparoscope and standard laparoscopic instruments were employed. This technique was evaluated in respects of operative time, estimated blood loss, intraoperative complications, drainage Lime, posl-opcrative visual analogue pain scale （VAPS）, post operative hospital stay and pathological change. Results All the procedures in this group were completed successfully with LESS. There was no additional trocarand conversion to standard laparoscopic or open surgery. Application of Quadport reduced the clash of instruments. Carefully performing surgery and avoiding blunt dissection to reduce intraoperative bleeding is the cornerstone of success. The operative time and estimated blood loss were （192.0±76.7） rain and （174. 6±167. 2） ml, respectively. There was no severe intraoperative complication and blood transfusion. The VAPS in the first post-operative day was （0.9±1.0） minutes and the drainage time was （3. 5± 1.7） d while post operative hospital stays were （7.9±3.4） d. There was no occurrence of secondary bleeding and wound infection. Conclusions I.ESS is a safe and feasible alternative for the treatment of urolugical tumors in elderly patients, but needs further clinical investigation.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2011年第6期500-502,共3页
Chinese Journal of Geriatrics
关键词
腹腔镜
泌尿外科手术
前列腺肿瘤
肾肿瘤
肾上腺皮质腺瘤
Imparoscopes
Urologic surgical procedures
Prostatic neoplasms
Kidney neoplasms
Adrenocortical adenoma
