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目的:探讨改良小切口经腹腹腔镜肾切除术的应用价值及其优势。方法:本组患者13例,均采用改良小切口经腹腹腔镜肾切除术。术前超声及CT扫描等检查测量肾脏的最短径作为小切口长度,辅助定位腹腔镜通道穿刺点。腹腔镜经腹行肾切除术,切除肾脏后经小切口取出。对手术时间、出血量、输血量、术后疼痛程度、术后恢复时间等资料进行观察记录。结果:本组患者均成功行腹腔镜肾切除术。手术时间(114±16)min(90～135min),术中失血(231±89)ml(100～350 m1),术中及术后输血0～400ml。术后第一个24 h视觉模拟量表(VAS)疼痛评分为3～6分。术后3天内使用双氯芬酸钠纳肛50～100mg/d。术后患者恢复进食时间1～2天,下床活动时间3～5天。13例患者术后平均随访2个月,均未出现严重并发症。结论:改良小切口经腹腹腔镜肾切除术能根据患者具体病情及肾脏解剖结构,个体化设计并充分利用腹腔镜的三个穿刺造通道。对患者损伤较小,术后恢复快,并且不增加手术并发症,具有较好的临床应用和推广价值。
Objective: To explore the value and advantages of modified small incision laparoscopic nephrectomy. Methods: Thirteen patients in this group were treated with modified small incision laparoscopic nephrectomy. Preoperative ultrasound and CT scan and other tests to measure the shortest diameter of the kidney as a small incision length, to help locate the laparoscopic puncture point. Laparoscopic transabdominal nephrectomy, removal of the kidneys removed by a small incision. The operation time, blood loss, blood transfusion, postoperative pain, postoperative recovery time and other data were observed and recorded. Results: All patients underwent laparoscopic nephrectomy successfully. The operative time (114 ± 16) min (90 ~ 135min), intraoperative blood loss (231 ± 89) ml (100 ~ 350m1) and intraoperative and postoperative blood transfusion 0 ~ 400ml. The first 24 h visual analog scale (VAS) pain score was 3 to 6 points after surgery. Within 3 days after the use of diclofenac sodium anal anal 50 ~ 100mg / d. Postoperative patients to resume feeding time of 1 to 2 days, ambulation time of 3 to 5 days. Thirteen patients were followed up for an average of 2 months, no serious complications. Conclusion: The modified small incision laparoscopic nephrectomy can design and make full use of three laparoscopic perforation channels according to the patient’s specific condition and renal anatomy. Less damage to the patient, rapid recovery after surgery, and does not increase the surgical complications, has good clinical application and promotion value.