Portless endoscopic radical nephrectomy via a single minimum incision in 80 patients
Portless endoscopic radical nephrectomy via a single minimum incision in 80 patients
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DOI：
10.1111/j.1442-2042.2004.00895.x
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发表时间：
2004-09-01
影响因子：
2.6
通讯作者：
Hyochi, N
中科院分区：
文献类型：
--
作者：
Kihara, K;Kageyama, Y;Hyochi, N
目的：评估我们的无孔内镜根治性肾切除术的可行性，通过一个最小的切口，在最初的80例患者中狭窄地允许提取标本。方法：对T1-3aN0M0型肾肿瘤患者，在内窥镜下经单小切口、无套管针、无气体行根治性肾切除术。所有使用的仪器都是可重复使用的。结果：平均切口长度6.6 cm，手术时间4 ~ 9 cm，预估出血量3 cm。1 h（范围，1.7-5.6 h）和324 mL（范围，10-2288 mL）。并发症发生率2.5% (2/80)；术后并发症为胸膜损伤及腔静脉出血，术中缝合修复。3例患者接受输血（3.8%）。平均到口腔喂养和步行的时间均为1.4天。术后第二天伤口疼痛最小，一般不需要使用镇痛药。与切口较小（6厘米或更小）的患者相比，切口较大（7厘米或更大）的患者估计失血量增加（平均约100毫升），恢复口服喂养的时间较晚（平均0.3天）。然而，两组患者的总体结果是相似的。对于肿瘤较大（7cm或更大）的患者，手术时间没有增加，并发症和输血都避免了。结论：单小切口无门内镜根治性肾切除术是T1-3aN0M0肾肿瘤患者安全、可重复性好、经济、微创的治疗选择。
Aim: To assess the feasibility of our portless endoscopic radical nephrectomy via a single minimum incision, which narrowly permitted extraction of the specimen in the initial 80 patients.Methods: Radical nephrectomy was carried out extraperitoneally in patients with T1-3aN0M0 renal tumors using an endoscope through a single minimum incision without trocar ports and gas. All the instruments used were reusable.Results: The average length of incision, operative time and estimated blood loss were 6.6 cm (range, 4-9 cm), 3. 1 h (range, 1.7-5.6 h) and 324 mL (range, 10-2288 mL), respectively. The complication rate was 2.5% (2/80); complications included injury of the pleura and hemorrhage from the vena cava, both of which were repaired by suture during operation. Transfusion was performed in three patients (3.8%). Average times to oral feeding and walking were both 1.4 days. Wound pain was minimal and analgesics were generally not required by the second postoperative day. In patients with larger incisions (7 cm or more), estimated blood loss increased (approximately 100 mL on average) and oral feeding resumed later (0.3 days on average), relative to patients with smaller incisions (6 cm or less). However, overall results were similar between the two patient groups. In patients with a large tumor (7 cm or greater), operative time did not increase and complications and transfusions were both avoided.Conclusion: Portless endoscopic radical nephrectomy via a single minimum incision is a safe, reproducible, cost-effective and minimally invasive treatment option for patients with T1-3aN0M0 renal tumors.