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目的:尝试经脐单切口三角腹腔镜肾盂癌根治切除术,探讨应用体会。方法:2016年12月~2017年1月,对4例患者(3例左侧,1例右侧)实施经脐单切口三角腹腔镜手术(又名经脐可拉伸切口多通道腹腔镜,SITUS手术)下肾盂癌根治术,包括经脐单切口三角腹腔镜条件下的肾脏、肾周脂肪、输尿管、部分膀胱切除,以及膀胱壁的缝合。术后经过经脐单一切口取出切除标本,并向心性缝合切口,达到术后疤痕融入肚脐,近似体表无疤的美容效果。结果:4例患者均顺利完成手术。术中添加2处5mm通道以帮助手术和术后留置引流管。手术时间平均(224.8±18.1)min,术中、术后均未输血,术后拔除引流管时间平均(3.9±0.3)d,术后住院时间平均(5.5±1.1)d。结论:经脐单切口三角腹腔镜手术肾盂癌根治术可行,术后可经过单一切口取出标本,术后疤痕可隐藏于脐周围,临床开展不需要特殊器械,手术安全可行。
Objective: To try the transvaginal incision laparoscopic radical nephrectomy for the treatment of renal pelvis cancer, to explore the application experience. METHODS: From December 2016 to January 2017, 4 patients (3 patients on the left and 1 patient on the right) underwent trans-umbilical single incision laparoscopic surgery (aka transabdominal multilayered laparoscopic transabdominal incision, SITUS surgery), including renal, perirenal fat, ureter, partial cystectomy, and suture of the bladder wall under single-incision trigonal laparoscopy. After surgery through a single incision through the umbilical cord removed specimens, and to suture the incision, to achieve postoperative scar integration into the navel, similar to the body scars without cosmetic effects. Results: All 4 patients completed the operation smoothly. During the operation, two 5-mm channels were added to assist the operation and indwelling the drainage tube. The average operation time was (224.8 ± 18.1) min. There was no blood transfusion during and after operation. The average drainage time after drainage was 3.9 ± 0.3 days, and the average postoperative hospital stay was 5.5 ± 1.1 days. Conclusions: Transvaginal single incision laparoscopic nephroureterectomy is feasible, and the specimens can be removed through a single incision after operation. The scar can be hidden around the umbilicus after operation. Special equipment is not required in clinical practice and the operation is safe and feasible.