摘要
目的完善相关术前评估并取得患者知情同意后,国内首次开展单孔多通道经腹3D腹腔镜肾切除术,探讨该手术的可行性和安全性,总结操作经验。方法 2013年8月5日,我科完成1例单孔多通道经腹3D腹腔镜下肾切除术(右侧)。患者术前检查示:肌酐81μmol/L;核素(99mTc DTPA)肾功能检查:右肾9.5mL/min,左肾65mL/min。诊断为"右肾重度积水",所以给予患者行右肾切除术。术中先于右侧腹直肌外侧缘脐水平上1cm处向头侧取长约3cm手术切口,在游离肾蒂动静脉后,分别离断肾脏动静脉,后于髂血管水平离断右侧输尿管。将肾脏装入取物袋,延迟切口至约4cm,从原切口取出。结果在不增加任何额外切口的情况下顺利完成手术,手术时间154min,术中出血150mL。患者术后第1天胃肠道功能恢复后进食。术后第1天患者术后检查示:肌酐为76μmol/L,术后第1天、第2天、第3天视觉模拟疼痛评分分别为2/10、1/10、0/10,术后未使用任何止痛药物,第3天出院,无任何术中或术后并发症。结论单孔多通道经腹3D腹腔镜下肾切除术安全、可行、有效。术后患者疼痛轻,恢复快,切口小。单孔3D腹腔镜由于手术图像立体感强,手术操作精确度高,手眼协调难度明显降低,具有良好的临床应用前景,但目前完成的病例数较少,仍需要临床经验积累。
Objective To summarize our experience on the first clinical case of transperitoneal 3D laparoendoscopic single-site（LESS） nephrectomy in China's Mainland, and to assess its safety and feasibility after obtaining the informed consents. Methods On August 5, 2013, we performed a 3D LESS nephrectomy using Karl Storz 3D endoscope and a multi-channel Quad-Port （OlympusTM） through a 3 cm skin incision at our institute. The patient was a 69 years old man, with a body mass index（BMI） of 27.7 kg/m2 and a preoperative serum creatinine level of 81 μmol/L. 99mTc DTPA was used to determine the glomerular filtration rate（GFR）. The preoperative unilateral renal function was 65 mL/min for the left side and 9.5 mL/min for the right side. And therefore he was diagnosed as “right kidney severe hydrocephalus” and received right nephrectomy. A 3 cm external retus incision was made at the umbilicus level at 1 cm site. After dissection of the renal pedicle blood vessels the renal blood vessels, the ureterogonadal packet was left en bloc and transected at the level when crossing the common iliac vessels. The kidney was extracted through the original incision after the skin incision was extended to 4 cm. Results The procedure was smoothly completed without any extra skin incision. The operating time was 154 min, with an estimated blood loss of 150 mL. The gastrointestinal function recovered on the first day after operation. Postoperative serum creatinine level on the first day was 76 μmol/L. Donor Visual Analog Pain Scores at postoperative day 1, 2 and 3 were 2/10, 1/10 and 0/10, respectively. The recovery of the patient was uneventful and he was discharged on the 3rd postoperative day. Conclusion Transperitoneal 3D laparoendoscopic single-site nephrectomy is safe, feasible and effective. It has the clinical benefits of less pain, rapid recovery and small incision. The procedure allows for a strong stereo perception, accurate manipulation, and a decreased demand for hand-eye coordination of hand, with a promising clinical future. But more clinical experience needs to be accumulated through more cases.
出处
《第二军医大学学报》
CAS
CSCD
北大核心
2013年第10期1116-1120,共5页
Academic Journal of Second Military Medical University
基金
上海市市级医院新兴前沿技术联合攻关项目(SHDC12010115)
军队临床高新技术重大项目(2010gxjs057)
上海市重点学科项目~~
关键词
肾切除术
单孔腹腔镜手术
3D腹腔镜手术
nephrectomy laparoendoscopic single-site surgery 3D laparoendoscopic surgery
