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目的探讨采用自制套管进行单孔腹膜后镜肾上腺切除术的可行性和初步经验。方法 2010年6月至2011年8月北京大学第一医院共有9例患者行单孔腹膜后镜肾上腺切除术。患者平均年龄59岁(32～80岁),男5例,女4例,平均BMI为24.1kg/m2。所有手术均为腹膜后入路,选择腋中线与腋后线之间髂嵴上方3cm处斜行切口,切口长度3～4cm。先以气囊扩张建立腹膜后腔,然后置入以手套自制单孔多通道套管建立手术入路,采用前端可弯曲腹腔镜器械联合常规腹腔镜器械完成手术,在术毕从切口取出标本。结果肿瘤长径平均3.3cm(1.5～5.5cm),左侧3例,右侧6例。平均手术时间62min(40～127min),术中平均出血量为50ml(0～200ml)。9例手术均顺利完成,无中转开放手术或增加附加套管,无术中、术后并发症发生。平均术后住院时间为5d(3～7d)。结论对于选择合适的病例,采用自制套管行单孔腹膜后镜肾上腺切除术是安全可行的,具有一定的美观效果,但远期疗效尚待观察,手术器械及手术技术尚待完善。
Objective To investigate the feasibility and preliminary experience of single hole retroperitoneoscopic adrenalectomy using homemade cannula. Methods From June 2010 to August 2011, a total of 9 patients undergoing single-hole retroperitoneoscopic adrenalectomy in Peking University First Hospital were enrolled. The average age of patients was 59 years (32 to 80 years), 5 males and 4 females, with an average BMI of 24.1 kg / m2. All operations were retroperitoneal approach, select the middle of the iliac crest between the axillary line and the axillary crest incision 3cm, the incision length of 3 ~ 4cm. The first use of balloon dilatation to establish retroperitoneal cavity, and then placed in gloves to create a single-hole multi-channel surgical approach, the use of flexible front laparoscopic instruments combined with conventional laparoscopic instruments to complete the operation, remove the specimen from the incision. Results The average length of the tumors was 3.3 cm (1.5-5.5 cm). There were 3 cases on the left and 6 cases on the right. The average operation time was 62min (40 ~ 127min). The mean intraoperative blood loss was 50ml (0 ~ 200ml). All the 9 cases were successfully completed. There was no need to transfer to open surgery or additional bushing. No intraoperative or postoperative complications occurred. The average postoperative hospital stay was 5 days (3 ~ 7 days). CONCLUSIONS: It is feasible and safe to choose a suitable one-hole percutaneous retroperitoneal adrenalectomy for the selection of appropriate cases. However, long-term efficacy remains to be seen. Surgical instruments and surgical techniques are yet to be improved.