3D单孔腹腔镜在泌尿外科手术中应用的单中心研究

目的 报道单中心开展的20例3D单孔腹腔镜手术,探讨该手术的可行性和安全性,总结操作经验,并评价其临床应用特点和价值。方法 收集2013年8月至2014年11月长海医院泌尿外科完成的20例3D单孔腹腔镜手术患者的临床资料和围手术期数据。20例患者中男性9例,女性11例。年龄31岁至69岁,平均55.8岁,平均体质指数24.64kg/m2。其中经腹腔入路14例,经腹膜后入路6例。9例肾上腺切除术,5例肾癌根治术,4例无功能肾切除术,1例肾部分切除术,1例腹膜后囊肿切除术。分析患者围手术期情况,手术时间、出血量、手术并发症和手术中转情况。结果 20例患者均在不增加任何额外切口的情况下顺利完成手术,无中转开放。在3D单孔腹腔镜下共完成5种类型手术,其中有肾上腺切除术、肾癌根治术和无功能肾切除术分别进行经腹腔镜入路和经腹膜后入路进行。本组20例3D单孔腹腔镜手术均未出现外科并发症。20例手术平均时间为156.3±56.1min,患者术后(4.5±1.6)d出院。术后第3天,15例患者疼痛评分为0分,3例为1分,2例为2分。结论 初步经验表明: 3D单孔腹腔镜下手术安全、可行、有效。3D腹腔镜由于手术图像立体感强,手术操作精确度高,手眼协调难度明显降低,能降低单孔腹腔镜手术操作的难度,具有良好的临床应用前景。目前3D单孔腹腔镜完成的手术例数较少,其长期临床疗效尚需前瞻性大样本多中心临床随机对照研究进一步证实。
Objective To assess the safety and feasibility of 3D laparoendoscopic single-site (3D-LESS) technique in urological operations. Methods Twenty patients received 3D-LESS urological operations in Changhai Hospital from August 2013 to November 2014, including 9 males and 11 females with an average age of 52.8years (31-69 years) and a BMI of 24.64kg/m2. Among 20 operations, 14 were completed via intraperitoneal approach and 6 via retroperitoneal approach; and there were 9 cases of adrenalectomy, 5 of radical nephrectomy, 4 of nephrectomy, 1 of partial nephrectomy and 1 of resection of retroperitoneal cyst. The perioperative parameters, operation time, blood loss, complications and transform to open surgery were analyzed. Results All twenty 3D-LESS operations were smoothly completed and no one was transformed to open surgery. In this study, there were 5 kinds of operations performed with 3D-LESS technique and 3 kinds (adrenalectomy, radical nephrectomy and nephrectomy) of operations performed via both intraperitoneal and retroperitoneal approach. During all the 20 operations, there were no surgical complications. The total operative time was 156.3±56.1min,the hospital stay after operation was 4.5±1.6 days. Donor Visual Analog Pain Scores at postoperative day 3 were 2/10 (2 cases), 1/10 (3 cases) and 0/10(15 cases), respectively. Conclusion Our initial experience shows that the 3D-LESS operation is safe, feasible and effective. The 3D imaging system provides anatomical layering similar to open surgery, and the 3D video techniques would make the LESS operation easier. However, more clinical experiences are needed to be accumulated in the future