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目的:介绍应用改良腹膜后穿刺位点行后腹腔镜肾脏手术的经验与总结。方法:收集84例不同肾脏疾病患者,其中男41例,女43例,平均年龄(45.6±11.8)岁。右侧46例,左侧38例。针对不同疾病及标本大小,设计了3种改良的腹膜后切口,分别命名为:M1,M2和M3,不同疾病患者选择与之适应的改良切口进行后腹腔镜手术,同时选择75例对照组行传统穿刺位点的后腹腔镜手术。结果:83例患者应用腹膜后改良穿刺位点顺利完成后腹腔镜手术,仅1例改为开放手术。平均手术时间(72±18)min,术中预估出血量(29±11)ml,术后无重大并发症和死亡。在改良术式的选择上,乳糜尿、无功能积水肾、肾囊肿患者全部通过M1法完成,仅有6例巨大的肾癌患者通过M3法完成手术。其余52例肾脏良恶性肿瘤中,19例通过M2法完成,33例仍然通过M1法完成。对比各项手术指标,其中M1和M2方式的术后美观评分高于传统腹腔镜组,M1(8.9±2.2),M2(8.7±2.5),传统腹腔镜(7.3±2.8)(P<0.05);改良组的双氯芬酸钠使用量小于传统组(50∶100mg,P<0.05),其余指标差异无统计学意义。结论:改良的腹膜后穿刺位点可以满足不同肾脏疾病的手术,具有美观和个性化的特征。
Objective: To introduce the experience and summary of retroperitoneal laparoscopic nephrectomy with modified retroperitoneal puncture site. Methods: Eighty-four patients with different kidney diseases were collected, including 41 males and 43 females, with an average age of (45.6 ± 11.8) years. 46 on the right and 38 on the left. Three kinds of modified retroperitoneal incision were designed according to the different diseases and the size of the specimens. They were named as M1, M2 and M3 respectively. The patients with different diseases were selected to undergo laparoscopic operation with modified incision. Meanwhile, 75 cases of control group Retroperitoneal laparoscopic surgery at a traditional puncture site. Results: In 83 patients, retroperitoneal puncture site was successfully laparoscopic retrospectively, and only 1 patient was changed to open surgery. The average operation time (72 ± 18) min, intraoperative blood loss forecast (29 ± 11) ml, no major complications and death after surgery. In the choice of modified surgery, chyluria, non-functional hydronephrosis, renal cysts were all completed by the M1 method, only 6 cases of huge renal cell carcinoma by M3 method to complete the operation. The remaining 52 cases of benign and malignant nephritic tumors, 19 cases completed by the M2 method, 33 cases are still completed by the M1 method. The postoperative aesthetic scores of M1 and M2 were significantly higher than those of conventional laparoscopic group (M1 (8.9 ± 2.2), M2 (8.7 ± 2.5), conventional laparoscopy (7.3 ± 2.8), P <0.05) ; The modified group’s dosage of diclofenac sodium is less than the traditional group (50: 100mg, P <0.05), the other indicators showed no significant difference. Conclusion: The modified retroperitoneal puncture site can meet the different kidney disease surgery, with a beautiful and personalized characteristics.