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目的:探讨3D腹腔镜技术在泌尿外科肾脏疾病手术中的应用。方法:我院于2013年3~10月完成3D腹腔镜肾脏手术52例,其中肾癌根治性术20例,肾部分切除术16例,单纯肾切除术12例,肾输尿管全切术4例。所有患者术前均行B超、IVU、CT或MRI检查,检测对侧肾功能正常,肾脏良性病变提示患肾无功能,肾脏恶性病变选择T1~T2N0M0的患者,肿瘤局限于肾包膜内,肾门及周围淋巴结无肿大,观察手术时间、术中出血量及手术效果。结果:52例手术全部获得成功,手术时间50~130min,其中肾癌根治术70~110min;肾部分切除术65~100min;肾蒂阻断时间14~25min,平均16.2min;单纯肾切除术50~90min;肾输尿管全切术60~130min;术中估计出血量为60~350ml,术中术后均未输血,术后住院5~9d,平均6d。术后病理提示肾母细胞瘤1例,乳头状肾细胞癌1例,肾错构瘤6例,肾透明细胞癌28例,输尿管尿路上皮癌4例,肾结核2例,肾萎缩样改变10例。以上所有患者切缘均为阴性,未见转移灶。术后随访1~7个月,无肿瘤复发及切口种植转移。结论:3D腹腔镜技术是传统腹腔镜技术的一大进步,降低了手术难度,缩短了手术时间。该系统具备腹腔镜与开放手术共同的优势,手术解剖更加精确,缝合操作相对容易,值得临床推广。
Objective: To investigate the application of 3D laparoscopy in urology renal disease surgery. Methods: From March to October 2013, 52 cases of 3D laparoscopic nephrectomy were completed. Among them, 20 cases of radical nephrectomy, 16 cases of partial nephrectomy, 12 cases of simple nephrectomy and 4 cases of radical nephroureterectomy . All patients underwent preoperative B-ultrasound, IVU, CT or MRI examination to detect contralateral renal function, benign renal lesions prompted renal non-functioning, malignant lesions of patients selected T1 ~ T2N0M0 patients, the tumor confined to the renal capsule, Renal and surrounding lymph nodes without swelling, observation of operation time, intraoperative blood loss and surgical results. Results: All the 52 surgeries were successful, the operation time was 50-130 minutes, of which the radical nephrectomy was 70-110 minutes; the partial nephrectomy was 65-100 minutes; the renal pedicle block time was 14-25 minutes (mean 16.2 minutes); simple nephrectomy 50 ~ 90min; radical ureteroscopy 60 ~ 130min; intraoperative blood loss was estimated at 60 ~ 350ml, intraoperative postoperative blood transfusion, postoperative hospital 5 ~ 9d, an average of 6d. Postoperative pathology suggestive of nephroblastoma in 1 case, papillary renal cell carcinoma in 1 case, renal hamartoma in 6 cases, renal clear cell carcinoma in 28 cases, ureteral urothelial carcinoma in 4 cases, renal tuberculosis in 2 cases, renal atrophy-like changes 10 cases. All the above patients were negative margins, no metastases. Follow-up 1 to 7 months after surgery, no tumor recurrence and incision implantation metastasis. Conclusion: 3D laparoscopy is a great advancement of traditional laparoscopic technique, which reduces the difficulty of operation and shortens the operation time. The system has the advantages of laparoscopy and open surgery, surgical dissection more accurate, suture operation is relatively easy, it is worth clinical promotion.