CAJ | 학술논문

目的初步总结单曲卡单孔腹腔镜手术在泌尿外科应用的体会。方法 2010年4-12月，施行单曲卡下的单孔腹腔镜手术45例。分别为腹腔镜下精索静脉高位结扎术17例，后腹腔镜下肾囊肿去顶减压术24例、输尿管切开取石术4例。腹腔镜手术组，在脐孔做15 mm切口，建立CO2气腹，穿刺入10 mm曲卡，置入整合工作通道的单通道腹腔镜，经上述工作通道放入操作器械，完成精索静脉高位结扎术。后腹腔镜手术组，在患侧髂嵴上3指做15 mm切口，IUPU法(Institute of Urology，Peking University的首字母缩写)建立后腹腔，同样方法穿刺入10 mm曲卡，置入整合工作通道的单通道腹腔镜，经工作通道放入操作器械，完成肾囊肿去顶减压术、输尿管切开取石术。结果两组45例患者，完成41例单曲卡下的腹腔镜手术，2例肾囊肿及2例输尿管结石，再增加一枚5 mm曲卡后完成手术。手术时间：腹腔镜组23～70 min；后腹腔镜组45～175 min。术中出血少，术后住院1～5d。两组术后均无明显并发症。结论对于一些比较简单的腹腔镜手术，完全可以施行一种全新的、更微创的单曲卡单孔腹腔镜手术来完成。
목적 초보총결단곡잡단공복강경수술재비뇨외과응용적체회。방법 2010년4-12월，시행단곡잡하적단공복강경수술45례。분별위복강경하정색정맥고위결찰술17례，후복강경하신낭종거정감압술24례、수뇨관절개취석술4례。복강경수술조，재제공주15 mm절구，건립CO2기복，천자입10 mm곡잡，치입정합공작통도적단통도복강경，경상술공작통도방입조작기계，완성정색정맥고위결찰술。후복강경수술조，재환측가척상3지주15 mm절구，IUPU법(Institute of Urology，Peking University적수자모축사)건립후복강，동양방법천자입10 mm곡잡，치입정합공작통도적단통도복강경，경공작통도방입조작기계，완성신낭종거정감압술、수뇨관절개취석술。결과 량조45례환자，완성41례단곡잡하적복강경수술，2례신낭종급2례수뇨관결석，재증가일매5 mm곡잡후완성수술。수술시간：복강경조23～70 min；후복강경조45～175 min。술중출혈소，술후주원1～5d。량조술후균무명현병발증。결론 대우일사비교간단적복강경수술，완전가이시행일충전신적、경미창적단곡잡단공복강경수술래완성。
ObjectiveTo report the initial urological applications of single trocar laparoscopic surgery. MethodsFrom April to December 2010, a total of 45 urologic patients underwent single trocar laparoscopic surgery. The procedures included high ligations of spermatics vessels (n = 17 ), unroofing of renal cysts (n =24) and ureterolithotomy (n =4). Transperitoneal approach: A 15 mm incision was made in umbilicus and CO2 pneumoperitoneum created. A 10-mm trocar was inserted into enterocoelia. After the installation of single punch laparoscope (STROZ), the operating instruments were guided through integrated working channel to complete operative procedures.Retroperitoneal approach: A 15 mm incision was made above thediseased-sidecristailiacafor around4cm.Retroperitonealcavitywaspreparedfor retroperitoneoscopy with the IUPU (Institute of Urology, Peking University) technique. In the same way, a 10-mm trocar wasinserted.And the single punch laparoscope was installed to complete operative procedures. ResultsThe procedures were successful in 41 cases.But the others ( renal cysts, n = 2 ;ureteral calculus,n = 2 )were successfully managed by adding a 5mm trocar.Operation time:transperitoneal approach, 23 -70 min; retroperitoneal approach, 45 -175 min. The intra-operative volume of blood loss was minimal. And the hospital stay was 1 - 5 days. No significant postoperative complication occurred. ConclusionFor some relatively simple procedures, a new and more minimally invasive approach of single trocar laparoscopic surgery may be attempted.