目的 报道单中心209例泌尿外科单孔多通道腹腔镜手术,并评价其临床应用特点和价值. 方法 前瞻性收集2008年12月至2012年7月209例泌尿外科单孔多通道腹腔镜手术患者的临床资料和围手术期数据.男121例,女88例.年龄(52.8 ±14.5)岁.体质指数(body mass index,BMI) (23.5 ±3.1 )kg/m2.既往腹盆腔手术史42例(20.1％).麻醉评分( american society of anesthesiologists score,ASA)(2.0±0.3)分.合并高血压61例(29.2％),糖尿病27例(12.9％).术前诊断为肾肿瘤70例(33.5％),肾上腺占位42例(20.1％),肾囊肿22例(10.5％),输尿管上段结石22例(10.5％),无功能肾脏19例(9.1％),BPH 10例(4.8％),其他24例(11.5％).探讨总体手术适应证、手术并发症和手术中转情况等临床特点,并将所有手术按完成时间先后分为两个阶段,每个阶段各22个月,进行相关参数的比较分析. 结果 本组共完成手术209例,其中上尿路手术193例(92.3％),肿瘤相关手术1 16例(55.5％),术中需重建的手术34例(16.3％),经腹腔途径手术169例(80.9％),经膀胱途径手术11例(5.3％),经脐切口手术98例(46.9％).总体手术中转率8.1％(17/209),其中增加一个5或10 mm辅助孔9例(4.3％),中转普通腹腔镜手术4例(1.9％),中转开放手术4例(1.9％).总手术并发症发生率16.3％(34/209),术中并发症发生率4.8％( 10/209),术后并发症发生率11.5％(24/209).两个阶段比较分析显示,手术总量从第一阶段的77例上升到第二阶段的132例,平均每月完成手术量分别为(3.5±3.0)和(6.0±3.5)例,两组比较差异有统计学意义(P＜0 05).第二阶段中肿瘤相关手术、根治性肾切除术和肾上腺切除术比例增高,经脐切口手术、肾囊肿去顶减压术和经膀胱前列腺剜除术比例减少,与第一阶段比较差异均有统计学意义(P＜0.05). 结论 对于具备丰富腹腔镜操作经验的术者,可用单孔腹腔镜技术成功完成各类泌尿外科手术,但仍有一定的手术并发症和手术中转风险,应严格把握手术适应证,尤其是初学者不宜开展需复杂重建或恶性肿瘤相关的单孔腹腔镜手术,应始终把手术安全和疗效放在首位.
目的 報道單中心209例泌尿外科單孔多通道腹腔鏡手術,併評價其臨床應用特點和價值. 方法 前瞻性收集2008年12月至2012年7月209例泌尿外科單孔多通道腹腔鏡手術患者的臨床資料和圍手術期數據.男121例,女88例.年齡(52.8 ±14.5)歲.體質指數(body mass index,BMI) (23.5 ±3.1 )kg/m2.既往腹盆腔手術史42例(20.1％).痳醉評分( american society of anesthesiologists score,ASA)(2.0±0.3)分.閤併高血壓61例(29.2％),糖尿病27例(12.9％).術前診斷為腎腫瘤70例(33.5％),腎上腺佔位42例(20.1％),腎囊腫22例(10.5％),輸尿管上段結石22例(10.5％),無功能腎髒19例(9.1％),BPH 10例(4.8％),其他24例(11.5％).探討總體手術適應證、手術併髮癥和手術中轉情況等臨床特點,併將所有手術按完成時間先後分為兩箇階段,每箇階段各22箇月,進行相關參數的比較分析. 結果 本組共完成手術209例,其中上尿路手術193例(92.3％),腫瘤相關手術1 16例(55.5％),術中需重建的手術34例(16.3％),經腹腔途徑手術169例(80.9％),經膀胱途徑手術11例(5.3％),經臍切口手術98例(46.9％).總體手術中轉率8.1％(17/209),其中增加一箇5或10 mm輔助孔9例(4.3％),中轉普通腹腔鏡手術4例(1.9％),中轉開放手術4例(1.9％).總手術併髮癥髮生率16.3％(34/209),術中併髮癥髮生率4.8％( 10/209),術後併髮癥髮生率11.5％(24/209).兩箇階段比較分析顯示,手術總量從第一階段的77例上升到第二階段的132例,平均每月完成手術量分彆為(3.5±3.0)和(6.0±3.5)例,兩組比較差異有統計學意義(P＜0 05).第二階段中腫瘤相關手術、根治性腎切除術和腎上腺切除術比例增高,經臍切口手術、腎囊腫去頂減壓術和經膀胱前列腺剜除術比例減少,與第一階段比較差異均有統計學意義(P＜0.05). 結論 對于具備豐富腹腔鏡操作經驗的術者,可用單孔腹腔鏡技術成功完成各類泌尿外科手術,但仍有一定的手術併髮癥和手術中轉風險,應嚴格把握手術適應證,尤其是初學者不宜開展需複雜重建或噁性腫瘤相關的單孔腹腔鏡手術,應始終把手術安全和療效放在首位.
목적 보도단중심209례비뇨외과단공다통도복강경수술,병평개기림상응용특점화개치. 방법 전첨성수집2008년12월지2012년7월209례비뇨외과단공다통도복강경수술환자적림상자료화위수술기수거.남121례,녀88례.년령(52.8 ±14.5)세.체질지수(body mass index,BMI) (23.5 ±3.1 )kg/m2.기왕복분강수술사42례(20.1％).마취평분( american society of anesthesiologists score,ASA)(2.0±0.3)분.합병고혈압61례(29.2％),당뇨병27례(12.9％).술전진단위신종류70례(33.5％),신상선점위42례(20.1％),신낭종22례(10.5％),수뇨관상단결석22례(10.5％),무공능신장19례(9.1％),BPH 10례(4.8％),기타24례(11.5％).탐토총체수술괄응증、수술병발증화수술중전정황등림상특점,병장소유수술안완성시간선후분위량개계단,매개계단각22개월,진행상관삼수적비교분석. 결과 본조공완성수술209례,기중상뇨로수술193례(92.3％),종류상관수술1 16례(55.5％),술중수중건적수술34례(16.3％),경복강도경수술169례(80.9％),경방광도경수술11례(5.3％),경제절구수술98례(46.9％).총체수술중전솔8.1％(17/209),기중증가일개5혹10 mm보조공9례(4.3％),중전보통복강경수술4례(1.9％),중전개방수술4례(1.9％).총수술병발증발생솔16.3％(34/209),술중병발증발생솔4.8％( 10/209),술후병발증발생솔11.5％(24/209).량개계단비교분석현시,수술총량종제일계단적77례상승도제이계단적132례,평균매월완성수술량분별위(3.5±3.0)화(6.0±3.5)례,량조비교차이유통계학의의(P＜0 05).제이계단중종류상관수술、근치성신절제술화신상선절제술비례증고,경제절구수술、신낭종거정감압술화경방광전렬선완제술비례감소,여제일계단비교차이균유통계학의의(P＜0.05). 결론 대우구비봉부복강경조작경험적술자,가용단공복강경기술성공완성각류비뇨외과수술,단잉유일정적수술병발증화수술중전풍험,응엄격파악수술괄응증,우기시초학자불의개전수복잡중건혹악성종류상관적단공복강경수술,응시종파수술안전화료효방재수위.
Objective To report a 4-year cumulative series (209 cases) of laparoendoscopic singlesite surgery (LESS) in urology and assess its clinical utilization. Methods Consecutive LESS cases done between December 2008 and July 2012 at our institution were prospectively recorded and retrospective analyzed in this study.Demographic data,main perioperative outcomes,and information related to the surgical technique were collected and analyzed.There were 209 patients ( 121 males and 88 females) with a mean age of (52.8 ±14.5) years,a mean B MIof (23.5 ±3.12) kg/m2 and a mean ASA score of (2.0±0.3).20.1％ (42 cases) of patients had previous abdominal or pelvic surgeries.29.2％ (61 cases) and 12.9％(27 cases) of patients had diabetes mellitus and hypertension. Indications were renal tumors (70 cases,33.5％),adrenal tumors (42,20.1％),renal cyst (22 cases,10.5％),ureteral calculi (22 cases,10.5％),nonfunctional kidneys (19 cases,9.1％),BPH (10 cases,4.8％),and others (24 cases,11.5％ ).Surgical conversions were evaluated,as well as intraoperative and postoperative complications.Two periods were arbitrarily dcfined:the first was from December 2008 to Septcmber 2010 (22 mon) and the second.was from October 2010 to July 2012 (22 mon).A comparative analysis between these two periods was conducted. Results There were 209 LESS surgeries included in this study.Most common procedures ( 92.3％ ) were done on the upper urinary tract,with 55.5％ of the whole cohort being tumor-related indications and only 16.3％ being reconstructive procedures.The transperitoneal approaches were preferentially adopted in 80.9％ cases,and transvesical access in 5.3％ cases. The transumbilical access was used in 46.9％ of cases.The overall conversion rate was 8.1％,with 4.3％ of cases converted to reduced - port laparoscopy,1.9％ to conventional laparoscopy,and 1.9％ to open surgery.The intraoperative complication rate was 4.8％ ( 10/209 ) and postoperative complications,mostly low grade,were encountered in 11.5％(24/209) of cases.There was a significant increase in the number of LESS cases during the second study period; the rate of some procedures (ie,transumbilical LESS,renal cyst decortication and transvesical single-port enucleation of the prostate) was lower,whereas some other procedures were performed more frequently (ie,tumor-related LESS procedures,radical nephrectomy and adrenalectomy). Conclusions A broad range of urological procedures can be finished with LESS technique in the experienced hands of a laparoscopic surgeons.However,LESS is still in its infancy with a certain risk of surgical complication and conversion.Stringent patient selection criteria should be applied,especially during the learning curve.Complex reconstructive procedures or malignant tumor related indications are not appropriate as the start of this kind of procedure.We need always put patient's safety and treatment efficacy first.
