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目的:探讨耻骨上辅助经脐单孔腹腔镜(SA-LESS)上尿路全切除术的可行性、有效性和技术要点。方法:对2例肾盂癌,2例输尿管癌,1例肾盂癌合并输尿管癌,2例肾结核,1例巨输尿管症并积脓、肾萎缩患者施行SA-LESS上尿路全切除术。患者全麻,取健侧70°卧位,于脐缘内侧置入两个Trocar,自患侧耻骨联合上方置入一个Trocar,分别置入远端可弯曲腹腔镜及操作器械。先游离患侧输尿管下段,予Hem-o-lok夹闭;向上游离肾脏并离断肾动静脉,切除肾脏;向下行袖套状切除输尿管末端周围膀胱壁,缝合膀胱切口;标本装袋,延长耻骨上切口取出。结果:8例手术均顺利完成。中位手术时间165(115~220)min,术中中位失血量140(50~200)ml。均未输血,术中未出现肠管、实质性器官和大血管损伤等并发症。均于术后第1天下床活动,第2~3天拔除腹腔和盆腔引流管,第6~7天拔除导尿管(肿瘤患者行膀胱灌注后),第8天出院。结论:SA-LESS上尿路全切除术安全可行,术后恢复快,住院时间短,美容优势明显,值得临床应用。
Objective: To investigate the feasibility, effectiveness and technical points of the suprapubic assistant upper-urinary total laparoscopic trans-umbilical laparoscopy (SA-LESS). Methods: SA-LESS total upper urinary total resection was performed in 2 cases of renal pelvic cancer, 2 cases of ureteral carcinoma, 1 case of renal pelvis cancer with ureteral carcinoma, 2 cases of renal tuberculosis, 1 case of giant ureter and empyema and renal atrophy. Patients under general anesthesia, take the contralateral 70 ° lying position, placed inside the umbilical edge of two Trocar, from the affected side of the pubic symphysis placed above a Trocar, respectively, into the distal flexible laparoscopy and operating equipment. First off the affected lower ureter, to Hem-o-lok clamp; upward free from the kidneys and renal artery and vein rupture, removal of the kidneys; downward cuff-like resection of the ureter around the bladder wall, suture the bladder incision; bagging, extension Remove the suprapubic incision. Results: All 8 cases were successfully completed. The median operative time was 165 (115-220) min with a median intraoperative blood loss of 140 (50-200) ml. No blood transfusion, intraoperative bowel, substantial organ and macrovascular injury and other complications. All patients were mobilized on the first day after operation. The abdominal and pelvic drainage tubes were removed on the second and third days, the catheter was removed on the 6th to 7th days after bladder perfusion. The patients were discharged on the 8th day. Conclusions: SA-LESS total upper urinary tract resection is safe and feasible, rapid recovery after surgery, short hospital stay and obvious cosmetic advantages, which are worthy of clinical application.