自制单孔后腹腔镜肾切除术的疗效及安全性评价.docVIP

自制单孔后腹腔镜肾切除术的疗效及安全性评价 　　[摘要] 目的 探讨自制单孔装置行后腹腔镜肾切除术的有效性及安全性。 方法 选择2012年7月～2013年7月解放军总医院泌尿外科行肾切除术患者50例为研究对象，根据手术方式的不同将其分为单孔腹腔镜组和开放手术组，每组各25例，单孔腹腔镜组给予自制单孔装置结合常规腹腔镜器械的手术。比较两组患者手术时间、术中出血量、切口长度、术后肠功能恢复时间、术后下床活动时间、住院时间等方面的差异，并比较白细胞（WBC）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、C反应蛋白（CRP）等指标的变化。 　　[关键词] 单孔腹腔镜手术；后腹腔镜；肾切除术 　　[中图分类号] R737.11 [文献标识码] A [文章编号] 1673-7210（2014）04（b）-0017-04 　　[Abstract] Objective To evaluate the efficacy and safety of the home-made single-port device in retroperitoneal laparoscopic nephrectomy. Methods 50 patients with nephrectomy from July 2012 to July 2013 in Uropoiesis Surgical Department of the PLA General Hospital were selected as study objects， they were divided into single-arch laparoscopic group and open surgery group， with 25 cases in each group. Single-arch laparoscopic group were given the operation of home-made single-port device combined with the conventional laparoscopic instruments. The time of operation， amount of bleeding， length of incision， recovery time of postoperation intestinal function， postoperation ambulation time， and hospital stays of two groups were compared， and the changes of WBC， ALT， AST， CRP were recorded and compared. Results All the 50 operations completed successfully， the time of operation， amount of bleeding， length of incision， recovery time of postoperation intestinal function， postoperation ambulation time， and hospital stays of single-arch laparoscopic group were better than those of open surgery group， the differences were statistically significant Conclusion Compared with the traditional open surgery， retroperitoneal laparoscopic nephrectomy combine with home-made single-port device is safe， feasible and effective. 　　[Key words] Laparoendoscopic single-site surgery； Ret-ropperitoneoscopy； Nephrectomy 　　随着腹腔镜技术的不断发展，常规腹腔镜手术已取代大部分开放手术，且人们对微创手术提出更高了要求，单孔腹腔镜技术（laparoendoscopic single-site，LESS）是在此基础上发展产生的。自2007年Raman等[1]首选报道单孔腹腔镜肾切除术，随后几年迅速发展，已有部分中心报道单孔腹腔镜肾癌根治术、肾上腺肿瘤切除术和肾输尿管全长切除术[2-3]，但手术入路多采用经腹腔途径，切口选择于脐部或脐周，经腹膜