Application of multi-purpose longitudinal incision upon the iliac crest in retro-peritoneal laparoscopic surgeries for kidney or adrenal gland
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摘要: 目的：探讨髂嵴上纵切口在后腹腔镜泌尿外科手术中的应用优势及推广。方法：选择2015年5月—2017年10月在我院采用三通道后腹腔镜途径治疗的肾上腺肿瘤及肾肿瘤患者159例，其中采用传统切口组72例，改良切口组87例，比较两组患者在取标本时间、切口长度（切口长度之和）、切口疼痛评分、切口并发症、下床活动时间、切口疝的发生率和切口复发率等方面的差异。结果：与传统切口组相比，在改良切口组采用肾上腺肿瘤切除术、肾部分切除术和肾癌根治术的病例具有更低的疼痛评分（P<0.05），其中在接受肾上腺肿瘤切除术和肾部分切除术的患者显示有更短的取标本时间、切口长度和更早的下床活动时间（P<0.05）。改良切口组的患者无切口麻木及膨出，并且由于切口较低，位于腰带的后方及下方，仅能看到不明显的两工作套管的切口瘢痕。结论：后腹腔镜手术采用髂嵴上纵切口既可以用于进观察镜也可用于取标本，具有减轻疼痛、降低切口长度、加快术后活动时间和切口隐蔽的优点，值得广泛开展。Abstract: Objective: To investigate feasibility and safety of longitudinal incision upon the iliac crest in radical, partial nephrectomy or adrenalectomy with retro-peritoneal laparoscopy.Methods: The retrospective study included 159 consecutive patients who underwent radical, partial nephrectomy or adrenalectomy between May 2015 and October 2017, and of them, 87 and 72 were used longitudinal and conventional horizontal incision during operation, respectively. We compared difference in time of specimen retrieval, sum length of incision, pain scores, complication associated with incision, time of started ambulation and incidence of incisional hernia between two groups.Results: Compared with patients undergoing conventional incision, pain scores in the patients undergoing modified incisions were lower(P<0.05). Moreover, patients who underwent partial nephrectomy or adrenalectomy had less length of incision, time of specimen retrieval and time of started ambulation(P<0.05). Concealed modified incision has cosmetic effect. In addition, no patients with modified incision has numb and bulge.Conclusion: Multi-purpose longitudinal incision would be an approach superior to conventional incision in retroperitoneal laparoscopic operations.
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