| Objective:To evaluate the clinical value of the umbilical laparoendoscopic single-site surgery simple nephrectomy by retrospectively analyzed the clinical indicators of the umbilical laparoendoscopic single-site surgery and transperitoneal conventional laparoscopic simple nephrectomy.Methods:Collected the clinical indicators of44patients who were underwent the umbilical laparoendoscopic single-site surgery or transperitoneal conventional laparoscopic simple nephrectomy between November2011and February2014in Xiangya Hospital. Divided the44patients into two groups, the umbilical-LESS group(group A) included10males and10females,13left and7right ipsilateral, aged from29to72years old, the mean age was52.45±10.53years old, the mean BI was22.55±2.23kg/m. The transperitoneal conventional laparoscopic group(group B) included7males and17females,13left and11right ipsilateral, aged from17to74years old, the mean age was50.92±13.80years old, the mean BMI was21.34±2.61kg/m2. Preoperative clinical data (including age, gender, body mass index, surgical side, merge serious illness, disease types), intraoperative indicators (including operative time, estimated blood loss, the total length of the incision, other transit surgery, intraoperative blood transfusion), postoperative clinical indicators (including recovery diet time, ambulation time, indwelling drainage tube time, postoperative hospital stay, total wound drainage, analgesic usage, visual analog pain scores, incision satisfaction scores), intraoperative and postoperative complications of two groups were analyzed retrospectively studied, and the results were statistically analyzed.Results:The total44surgeries were successful and there were no conversion to open surgery. There were2cases plus5mm auxiliary Trocar,1cases plus10mm auxiliary Trocar,2cases of intraoperative blood transfusion in the umbilical-LESS group; there was1case plus10mm auxiliary Trocar, no intraoperative blood transfusion in the transperitoneal conventional laparoscopic group. In umbilical-LESS group (group A) and conventional transperitoneal laparoscopic group (group B), the mean operative time were202.50±53.89,170.21±40.47min respectively; intraoperative estimated blood loss were138.50±80.85,132.71±60.90ml respectively; incision total length were3.72±0.41,5.07±0.50cm respectively; recovery diet time were3.20±1.11,3.21±0.59d respectively; ambulation time were3.80±1.40,4.21±1.25d respectively; indwelling drainage time were6.15±2.28,6.25±1.39d respectively; postoperative hospital stay were7.65±2.21,8.42±1.84d respectively; wound total drainage volume was137.75±36.90,126.46±30.16ml respectively; analgesic usage was20.0%and54.2%respectively; visual analog pain scores were3.15±1.27,3.88±0.95respectively; incision satisfaction scores were4.50±0.51,3.92±0.72respectively; there were7cases had intraoperative or postoperative complications in the umbilical-LESS group (group A), including3cases of subcutaneous emphysema,1case of hypercapnia,2cases of vascular injury,1case of wound infection; there were5cases had intraoperative or postoperative complications in the transperitoneal conventional laparoscopic group, including2cases of subcutaneous emphysema,2case of hypercapnia,1 case of urinary tract infection. Both of two groups had no umbilical hernia or intestinal obstruction during postoperative follow-up period. The preoperative clinical data (including gender, body mass index, surgical side, merge serious illness, disease types) of two groups had no significant difference (P>0.05). In the intraoperative indicators, the estimated intraoperative blood loss, transit other surgery, intraoperative blood transfusion of two groups had no significant difference (P>0.05); the operative time, the total incision length of two group had a significant difference (P<0.05). In the postoperative indicators, the recovery diet time, ambulation time, indwelling drainage tube time, postoperative hospital stay, total wound drainage of two groups had no significant difference (P>0.05); the analgesic usage, visual analogue pain scores (VAPS), incision satisfaction scores of two groups had a significantly different (P<0.05). There was no significantly different in intraoperative or postoperative complications between two groups (P>0.05).Conclusion:1. The umbilical-LESS simple nephrectomy were safe and effective;2. Compared with the transperitoneal conventional laparoscopic simple nephrectomy, the umbilical-LESS simple nephrectomy was more difficult to operate, required longer operative time and longer learning curve;3. The umbilical-LESS simple nephrectomy had better cosmetic results and lighter postoperative pain than the transperitoneal conventional laparoscopic simple nephrectomy;... |
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