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目的:探讨采用自制套管进行单孔腹膜后镜上尿路肿瘤根治性手术的可行性和初步经验。方法:2010年7月~2011年7月,采用单孔腹膜后镜上尿路肿瘤根治性手术行肾癌根治术5例、肾输尿管全长切除术7例。均选择腋中线与腋前线之间髂嵴上方3cm处斜行切口,先以气囊扩张建立腹膜后腔,然后置入以手套自制多通道套管建立手术入路,采用前端可弯曲腹腔镜器械联合常规腹腔镜器械完成手术,术毕延长切口取出标本或另取切口完成手术并取出标本。结果:12例手术均顺利完成,无中转开放手术或增加附加套管。平均腔镜手术时间94(60~191)min,术中平均出血83(0~400)ml。平均术后住院7(5~10)d。术后1例(8.3%)发生泌尿系感染,余无并发症发生。结论:对于选择合适的病例,采用自制套管行单孔腹膜后镜肾癌根治术和肾输尿管全长切除术安全可行,但远期疗效有待观察,手术器械及手术技术尚待完善。
Objective: To explore the feasibility and preliminary experience of radical cuff surgery with a single hole peritoneal retroperitoneal urethral tumor. Methods: From July 2010 to July 2011, 5 cases of radical nephrectomy and 7 cases of total nephroureterectomy were performed with the single hole pneumoperitoneum. Choose axillary midline and axillary line above the iliac crest 3cm oblique incision, the first expansion of the balloon to establish the retroperitoneal cavity, and then set into the glove home-made multi-channel casing to establish surgical approach, the use of flexible front laparoscopic instruments combined Conventional laparoscopic instruments to complete surgery, surgery to extend the incision to remove the specimen or another incision to complete the operation and remove the specimen. Results: All the 12 surgeries were completed successfully. There was no need to transfer to open surgery or add additional cannula. The mean time of endoscopic surgery was 94 (60-191) min, mean intraoperative bleeding was 83 (0-400) ml. The average postoperative hospital 7 (5 ~ 10) d. One patient (8.3%) had urinary tract infection after operation, and no complication occurred. CONCLUSIONS: It is safe and feasible to choose a suitable single-hole, single-hole retroperitoneal nephrectomy and full-length ureteroscopic resection for the selection of appropriate cases. However, long-term efficacy remains to be seen. Surgical instruments and surgical techniques are yet to be improved.