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目的:总结经脐单孔腹腔镜治疗肾脏输尿管疾病的手术经验,并探讨其可行性。方法:2009年8月至2011年1月采用自制多通道单孔设备为6例无功能积水肾脏患者行肾切除术、为12例输尿管上段结石患者行输尿管切开取石术。术中所用的自制通道由两个环和一个无菌手套制作而成。取脐旁2 cm切口,置入自制多通道,将普通器械与可弯器械相配合,完成肾切除或肾盂输尿管切开取石术,切除标本由脐部切口取出。结果:17例顺利完成单孔腹腔镜手术,1例因术中腹主动脉损伤而中转开放手术。手术时间平均(123.3±23.4)min,术中平均出血(86.5±12.4)ml,平均住院7d,术后平均留置引流管3.5d。术后随访2~14个月,脐部切口愈合良好,无脐疝等并发症发生。结论:采用自制的多通道设备行经脐单孔腹腔镜手术治疗上尿路病变安全可行,切口瘢痕隐蔽,具有良好的美容和微创效果,为上尿路疾病的治疗提供了新的选择。
Objective: To summarize the surgical experience of transurethral single-hole laparoscopy in the treatment of renal ureter disease and to explore its feasibility. Methods: From August 2009 to January 2011, 6 cases of non-hydronephrosis kidney nephrectomy were performed with self-made multi-channel single-hole device. 12 cases of ureteral calculi were treated by ureterolithotomy. The self-made channel used during surgery consists of two rings and a sterile glove. Take a 2 cm incision next to the umbilical cord and put it into a homemade multi-channel. The common instrument is matched with the bendable instrument to complete the nephrectomy or ureteropelvic lithotomy. The resected specimen is taken out from the umbilicus incision. Results: Seventeen patients underwent single-hole laparoscopic surgery successfully and one underwent open surgery because of abdominal aorta injury. The average operation time was (123.3 ± 23.4) min, mean intraoperative bleeding was (86.5 ± 12.4) ml, average hospitalization was 7 days, and the average postoperative drainage tube was 3.5 days. Follow-up postoperative 2 to 14 months, umbilical incision healed well, no complications such as umbilical hernia. Conclusion: It is safe and feasible to use homemade multi-channel device to treat upper urinary tract disease through single-hole laparoscopic umbilical laparoscopic surgery. The incision scar is hidden and has good cosmetic and minimally invasive effects. It provides a new choice for the treatment of upper urinary tract diseases.