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目的:报告经脐单孔腹腔镜阴式肾切除术的经验与体会,初步探讨其临床应用价值。方法:1例右侧输尿管上段结石并右肾重度积水、右肾无功能和1例左侧输尿管下段结石并左肾重度积水、左肾无功能患者均行经脐单孔腹腔镜阴式肾切除术。患者取截石位,患侧腰部垫高,取脐缘弧形切口长约3 cm,分别置入Trocar及腹腔镜、操作器械。按照普通腹腔镜方法,充分游离肾脏后将其完整切除,装入自制标本袋,于阴道后穹窿分别切开长约3 cm、4 cm切口,将标本自阴道取出。结果:2例手术均顺利完成,手术时间分别为160 min、260 min,术中失血量分别为150 ml、280 ml。均于术后第1天下床活动。例1于术后第2天肛门通气并进饮食,术后腹腔引流管引出淡红色液体较少,术后第6天无液体引出予拔除;术后第7天脐部切口拆线痊愈出院。例2术后肠道功能恢复延迟,腹胀,经对症治疗于术后第11天肛门通气并进饮食;术后第12天拔除腹腔引流管并拆线痊愈出院。脐部切口均不明显,阴道切口愈合良好。结论:对有手术指征的患者行经脐单孔腹腔镜阴式肾切除术,脐部切口术后恢复后被周围的皱褶所遮蔽,美容效果良好,且能有效预防脐部切口疝形成,值得临床选用。
OBJECTIVE: To report the experience and experience of transvaginal laparoscopic transrectal nephrectomy via umbilical cord to explore its clinical value. Methods: One case of right upper ureteral calculi with right kidney hydronephrosis, right renal nonfunction and 1 case of left lower ureteral calculi and left kidney with severe hydronephrosis, left renal dysfunction were performed via single umbilical laparoscopic vaginal kidney cut. Patients take lithotomy position, ipsilateral lumbar lord, take umbilical edge curved incision about 3 cm, were placed in Trocar and laparoscopy, operating equipment. According to ordinary laparoscopic method, the full removal of the kidney after its complete resection, into the homemade specimen bag in the vaginal fornix were cut about 3 cm, 4 cm incision, the specimen removed from the vagina. Results: All the 2 surgeries were successfully completed. The operative time was 160 min and 260 min respectively. The intraoperative blood loss was 150 ml and 280 ml respectively. The first day after bed activity. Example 1 On the 2nd postoperative day anal ventilation and into the diet, the postoperative abdominal drainage leads to less light red liquid, 6 days after surgery without lead to the removal of liquid; umbilical incision on the 7th postoperative stump cured and discharged. Example 2 postoperative recovery of intestinal function delay, abdominal distension, symptomatic treatment on the 11th day postoperative anal ventilation and into the diet; on the 12th day after removal of the abdominal drainage tube and stitches cured and discharged. Umbilical incision are not obvious, vaginal incision healed well. Conclusions: The umbilical single-hole laparoscopic vaginal nephrectomy is performed in patients with surgical indications. After the umbilical incision is recovered, the umbilical cord is obscured by the surrounding folds, which has good cosmetic effect and can effectively prevent the umbilical incision hernia formation. Worth clinical selection.