肾结石是泌尿外科最常见的疾病之一,其发病率在各年龄段和不同性别中都呈现出上升趋势.目前主要以手术治疗为主,虽然近年来手术技术得到飞速发展,外科医生对于肾结石的处理更加得心应手,但外科手术无法降低术后结石的高复发率.现有药物的治疗效果不尽人意,仍缺少预防结石形成和复发的特异性药物.槲皮素具有强大的抗炎、抗氧化等功能,在包括肿瘤在内的多种疾病中发挥作用.近年来研究发现,槲皮素能够通过抗氧化损伤、调节肾脏代谢等多种途径有效地抑制肾结石的形成.槲皮素可能为结石的治疗提供新的选择.

目的 系统评价坦索罗辛联合丁溴东莨菪碱在泌尿系结石体外冲击波碎石(ESWL)后辅助排石的效果及安全性.方法 计算机检索中国知网、万方、VIP、CBM、PubMed、Cochrane Library、Web of Science核心合集数据库,检索时限从建库至2022年4月,查找坦索罗辛联合丁溴东莨菪碱辅助ESWL治疗泌尿系结石的随机对照试验,试验组ESWL后给予坦索罗辛+丁溴东莨菪碱,对照组ESWL后给予丁溴东莨菪碱.采用RevMan 5.4软件进行meta分析,分析两组有效率、排石时间、肾绞痛消失时间、疼痛评分及不良反应情况,其中根据排石时间单位选择分为小时组、天数组;根据评分量表选择分为视觉模拟评分法(VAS)组、数字疼痛评分法(NPRS)组.结果 共纳入8篇文献,1 762例患者.试验组有效率高于对照组(RR=1.21,95％CI:1.16,1.26,P＜0.000 01).小时组排石时间短于对照组(SMD=-5.50,95％CI:-6.59,-4.41,P＜0.00001).天数组排石时间短于对照组(SMD=-4.21,95％CI:-6.40,-2.03,P=0.000 2).试验组肾绞痛消失时间短于对照组(SMD=-2.04,95％CI:-2.18,-1.91,P＜0.00001).VAS组疼痛程度低于对照组(SMD=-0.65,95％CI:-0.90,-0.39,P＜0.000 01).NPRS组疼痛程度低于对照组(SMD=-1.59,95％CI:-1.80,-1.38,P＜0.000 01).两组不良反应比较,差异无统计学意义(P＞0.05).结论 坦索罗辛联合丁溴东莨菪碱辅助ESWL治疗泌尿系结石可以提高治疗的有效率,促进结石排出、缩短疼痛时间及减轻患者疼痛症状,是一种安全有效的方法.

目的 探讨末端可弯输尿管吸引鞘联合输尿管软镜治疗上尿路结石的安全性和有效性.方法 回顾性分析2022 年2～8 月采用末端可弯输尿管吸引鞘联合输尿管软镜治疗75 例上尿路结石的资料.肾结石57 例,输尿管上段结石12例,肾结石合并输尿管上段结石6 例.左侧31 例,右侧36 例,双侧8 例.结石长径(18.7±5.2)mm,CT值(1052.4±288.6)HU.结果 75 例手术均顺利,术中均未发生严重并发症.手术时间(58.6±13.6)min,术后住院时间(2.9±1.0)d.术后第1 天结石清除率86.7%(65/75),术后 30 天结石清除率 93.3%(70/75).术后并发症 5 例,包括感染性休克 1 例,发热 3例,血尿1 例,均治愈.结论 末端可弯输尿管吸引鞘联合输尿管软镜治疗上尿路结石安全、可行,疗效确切.

输尿管软镜碎石术是治疗上尿路结石主要手术方式之一,具有疼痛轻、恢复快、并发症少等优点.近年来,随着内窥镜的小型化、成像技术的不断提高、偏转角度的改进以及辅助碎石工具的运用,输尿管软镜碎石术的适应证在不断扩大,尤其适用于一些特殊人群患者,其中包括儿童、肥胖、孕妇、孤立肾患者.本文就输尿管软镜治疗特殊人群肾结石研究进展进行综述.

目的:总结局麻下输尿管软镜碎石术治疗高危上尿路结石患者的经验,评价其可行性、安全性及有效性.方法:选取2019年3月至2021年3月我院泌尿外科实施局麻下输尿管软镜碎石术治疗高危上尿路结石患者15例.术前麻醉风险评估ASAⅢ级10例,ASAⅣ级5例.单侧肾结石8例,单侧输尿管上段结石4例,单侧肾及输尿管上段结石1例,双侧肾结石2例;结石大小0.8～3.0 cm,平均1.7 cm.术前患侧留置双J管1周以上,术中采用奥布卡因凝胶行尿道麻醉,2％利多卡因注射液行膀胱和输尿管麻醉,随后行输尿管软镜碎石术.记录手术时间、术中疼痛视觉模拟评分(VAS)、术后血红蛋白下降值、手术并发症、结石清除率、术后住院时间等指标.结果:15例患者共行20次局麻软镜碎石术,患者耐受性均良好,无患者因疼痛终止手术,其中2例双肾结石分期行手术,1例单侧肾及输尿管上段结石先后行2次手术,1例孤立肾肾结石负荷大先后行3次手术.手术时间(59.2±14.0)min,术中VAS评分(1.8±0.6)分;术后血红蛋白下降值(9.5±8.7)g·L-1.术后发热1例,脓毒血症1例,均治疗后痊愈,无死亡病例;术后住院时间为(3.2±1.5)d.术后1个月结石清除率为86.7％(13/15).结论:局麻下输尿管软镜碎石术治疗全麻高危患者合并上尿路结石安全、可行、有效.

输尿管医源性损伤是输尿管镜手术和盆腹腔手术较常见的并发症,输尿管长段狭窄和缺损时有发生,临床治疗极为棘手.输尿管长段病损治疗方法主要包括输尿管皮肤造口术[1]、回肠代输尿管术[2]、膀胱肌瓣输尿管成形术[1,2]、自体肾移植术[3]等.我院2018年8月～2019年12月应用腹腔镜膀胱肌瓣输尿管成形术治疗输尿管长段病损5例,效果满意,现报道如下.

目的:比较耻骨上辅助单孔腹腔镜手术(SA-LESS)与后腹腔镜手术(RPLS)治疗肾上腺囊肿的疗效.方法:回顾性分析赣南医学院第一附属医院2014年1月-2019年8月收治的23例肾上腺囊肿患者的临床资料,其中男11例,女12例;年龄22～63岁,平均41岁;囊肿最大径3.10～11.10 cm,平均5.99 cm;左侧16例,右侧7例.除3例因腰腹部就诊外,均为体检发现.按手术方式分为SA-LESS组(15例)和RPLS组(8例).比较两组患者基本信息、围手术期资料.结果:两组患者在性别比例、BMI、囊肿最大径、侧别等方面比较差异无统计学意义,SA-LESS组平均年龄(37.20±9.56)岁,显著低于RPLS组(48.13±13.32)岁(P＜0.05).23例手术均成功,无术中及术后严重并发症发生.两组手术时间、术中失血量、引流管拔除时间及术后住院时间比较差异无统计学意义.在SA-LESS组胃肠道功能恢复时间(18.40±4.79)h长于RPLS组(12.75±5.65)h,差异有统计学意义(P＜0.05).术后48 h视觉模拟疼痛评分(VAPS),SA-LESS组显著低于RPLS组[(1.60±0.63)分vs.(2.25+0.46)分,P＜0.05]].术后3个月患者瘢痕评价调查问卷(PSAQ)评分,SA-LESS组显著低于RPLS组[(32.33±1.98)分vs.(39.88±2.85)分,P＜0.05].术后病理报告示:肾上腺内皮性囊肿12例,假性囊肿11例.术后随访24～84个月,平均46.3个月,囊肿均无复发.结论:SA-LESS与RPLS治疗肾上腺囊肿安全、有效,与RPLS比较,SA-LESS术后疼痛更轻,美容效果更佳.

目的:探讨硕通镜治疗输尿管石街的临床疗效.方法:回顾性分析2018年3月-2020年3月在我院采用硕通镜下钬激光碎石术治疗输尿管石街患者的临床资料.患者共12例,男8例,女4例;年龄25～62岁,中位年龄44岁;输尿管石街长5.2～10.8 cm,平均7.4cm.观察一期手术成功率、手术时间、结石清除率、术中及术后并发症发生情况.结果:12例患者均一期顺利完成手术,手术时间40～100 min,平均60 min,术中未发生肾盂输尿管黏膜穿孔、撕脱、断裂以及大出血、感染性休克等严重并发症.术后住院时间1～3 d,平均1.5d,1例术后出现发热,对症治疗后痊愈,无其他术后并发症发生.术后第1天和术后1个月的清石率分别为83％和92％.术后1个月均顺利拔除双J管,复查彩超肾积水较术前减轻,未见肾周积液及血肿形成.复查肾功能较术前改善.结论:硕通镜治疗输尿管石街安全、有效.

目的 评价超选择性髂内动脉栓塞术治疗晚期前列腺癌合并难治性出血的安全性及疗效.方法 应用弹簧钢圈及聚乙烯醇颗粒,对2例晚期前列腺癌合并难治性出血患者进行超选择性髂内动脉栓塞术,观察其临床疗效.结果 本组2例超选择性髂内动脉栓塞术均获成功,术后出血症状明显改善,持续监测血红蛋白、红细胞压积保持平稳,分别随访44、4个月,无再发严重出血.结论 超选择性髂内动脉栓塞术治疗晚期前列腺癌难治性出血安全、有效,值得临床选用.

总结耻骨上机器人辅助经脐双通道腹腔镜巨大嗜铬细胞瘤/副神经节瘤(pheochromocytoma and paraganglioma,PPGL)切除术的经验与体会,探讨其安全性和可行性.回顾性分析2019年8月-2020年3月我院施行的5例耻骨上机器人辅助经脐双通道腹腔镜巨大PPGL切除术的临床资料.男4例,女1例,中位年龄45.5(26～57)岁,中位BMI 23.4(20.4～24.8) kg/m2.中位收缩压142(115～220) mmHg,中位舒张压106(78～140) mmHg,中位心率98(72～114)次/min.伴有高血压病史3例,其中1例曾有脑梗死病史;其余2例无特异性症状,为体检时发现.肿瘤位于右肾上腺区3例,左肾上腺区1例,左肾门部1例;中位肿瘤最大径6.5(6.0～8.3) cm.术前中位24 h尿多巴胺896.4(650.7～1 236.3) μg/24 h,中位24 h尿去甲肾上腺素450.7(114.6～775.8) μg/24 h,中位24 h尿肾上腺素66.5(45.6～114.8) μg/24 h,均升高.记录手术时间、出血量及住院时间等指标.本组5例手术均顺利完成,无中转开放或普通腹腔镜手术.中位手术时间115(75～165) min,中位术中估计失血量90(50～180) mL.术中、术后均未发生严重并发症,均未输血.所有患者术后恢复顺利.术后24 h中位视觉模拟疼痛评分(VAS)2(1～3)分,术后第1～2天下床活动,术后第2～3 d拔除腹腔引流管.中位术后住院时间4(3～6)d.术后病理诊断:嗜铬细胞瘤3例,副神经节瘤2例.所有患者均获随访,中位随访时间5(2～9)个月.切口愈合良好,脐部瘢痕因被脐部皱褶遮蔽而不明显,耻骨上切口被阴毛遮蔽而不易察觉;无肿瘤复发;24 h尿儿茶酚胺均恢复正常;术前3例血压升高者,术后血压均恢复正常2例,1例仍需口服降压药治疗,但药量减少且血压控制良好.耻骨上机器人辅助经脐双通道腹腔镜巨大PPGL切除手术安全、可行,且美容优势显著,值得临床应用.

INTRODUCTION AND OBJECTIVE: To explore the clinical application value of Suprapubic-assisted laparoendoscopic single-site surgery (SA-LESS) ureteral stricture resection and re-anastomosis in upper and middle ureteral stenosis. METHODS: From January 2016 to December 2018, 18 patients with upper ureteral stenosis were randomly divided into two groups (group A and group B, 9 cases in each group). Group A was performed SA-LESS technology, which was independently innovated by our hospital, to perform laparoscopic resection and re-anastomosis of ureteral stenosis. Group B was performed standard three-site laparoscopic resection and re-anastomosis of ureteral stenosis. 13cases from January 2013 to December 2013 (Group C) of open ureteral stricture were selected as control. The clinical data of all cases were collected, including the causes of ureteral stricture, the length of stricture, the function of kidney, the time of operation, the amount of bleeding during the operation, the time of hospitalization after the operation, the cosmetic effect after the operation, the complications of urinary extravasation and restenosis. RESULTS: Both the SA-LESS group and the standard laparoscopic group were successfully operated without increasing the working channel. There was no conversion to open surgery. In the open group, 13 operations were successful. The operative time of the three groups was 135.4 ± 20.2min, 121.9 ± 18.5min and 108.9 ± 15.4min respectively, p = 0.073, and no significant difference in statistics. the intraoperative blood loss of the three groups were 62.4 ± 5.4ml, 64.3 ± 7.5ml, 80.5 ± 20.4ml and p < 0.05 respectively. The intraoperative blood loss of the SA-LESS group and the standard laparoscopic group was less than that of the open operation group. The postoperative pain scores of the three groups were 2.3 (1-4), 2.8 (1-4) and 3.6 (2) respectively, the pain score of SA-LESS group and standard laparoscopic group was lower than that of open operation group. The postoperative beauty score of SA-LESS group was 38.24 ± 3.22, 35.63 ± 3.52 and 33.42 ± 4.12, respectively, and the beauty effect of SA-LESS group and standard laparoscopic group was better than that of open operation group. In addition, there was no significant difference in the postoperative hospitalization time, postoperative urinary extravasation and restenosis among the three groups. CONCLUSIONS: Suprapubic-assisted laparoendoscopic single-site resection and anastomosis of ureteral stricture is safe and feasible for the treatment of ureteral middle and upper segment stricture. It has the advantages of little postoperative pain and good cosmetic effect, and is worthy of clinical selection application. Source of Funding: National Nature Science Foudation of China (Grant no. 81860456)

膀胱内异位前列腺是指在膀胱内出现前列腺组织,在临床上较为罕见,容易误诊为膀胱肿瘤,我院泌尿外科最近收治了1例膀胱内异位前列腺患者,现报道如下: 1 临床资料 患者,男,34岁,因左侧腰痛半年余于2020年4月入院.患者半年前开始反复出现左侧腰痛,以胀痛为主.无尿频、尿急、尿痛,无肉眼血尿,无排尿困难等症状.专科查体:左侧肾区叩击痛,余查体未见明显异常.泌尿系彩超提示:左输尿管结石并左肾轻度积水,双肾结石;前列腺钙化;膀胱未见明显异常.门诊拟以尿石症收入我科.入院后查泌尿系CT平扫和静脉尿路造影均未提示膀胱肿物.完善术前准备,患者在全麻下行左侧输尿管软镜碎石术,术中偶然发现膀胱三角区一大小约0. 3cm×0.5cm隆起样病变(图1),半球形、基底较宽、表面光滑、边界清楚,肿物电切后送病理检查,结果显示:送检物镜下为前列腺组织,其中见钙盐沉积(图3、图4).结合临床考虑为膀胱内异位前列腺.患者恢复良好,术后3天出院.术后随访3个月,复查膀胱镜未见异常.

目的 探讨二氧化碳(CO2)气相软性输尿管镜治疗肾结石的应用研究.方法 对2例诊断为单侧肾结石的患者行CO2气相软性输尿管镜碎石术,2例患者术前均未留置双J管,故先应用输尿管硬镜行患侧输尿管镜检查术,未见异常后留置斑马导丝,沿斑马导丝置入12F软性输尿管镜导入鞘(以下简称软镜鞘),应用电子软性输尿管镜置入软镜鞘,在软镜灌注接口连接气腹机,向肾盂内灌注CO2气体,压力设置为10-12mmHg,运用钬激光光纤在CO2气相环境中进行碎石.结果 软性输尿管镜在CO2气相环境中视野清晰度尚可,镜检寻及结石后开始碎石,碎石约10min后,出现气液混合界面,视野逐渐不清,无法继续手术,立即改为注射器推注生理盐水后顺利完成手术,手术时间分别为47min和55min,未发生出血,穿孔,感染等的并发症.结论 CO2气相软性输尿管镜碎石术为一种新型的碎石技术,初期视野清晰,但随着碎石进行,逐渐出现气液混合界面,导致视野不清,在临床上有一定的应用价值,但需进一步改进设备和技术.

ObjectivesTo compare suprapubic‐assisted laparoendoscopic single‐site surgery nephrectomy with standard laparoscopic nephrectomy.MethodsA retrospective case–control study comparing three surgeons’ experience with 122 suprapubic‐assisted laparoendoscopic single‐site surgery nephrectomy and 107 standard laparoscopic nephrectomy was carried out. Operative time, estimated blood loss, intraoperative complications, intraoperative conversion, postoperative bowel recovery, postoperative analgesics, postoperative visual analog pain scale score, postoperative length of stay, days before going back to work, postoperative complications and Patient Scar Assessment Questionnaire were compared after propensity score matching.ResultsA total of 97 matched pairs were obtained after propensity score matching. There were no statistically significant differences between the suprapubic‐assisted laparoendoscopic single‐site surgery nephrectomy and standard laparoscopic nephrectomy groups with respect to operative time, estimated blood loss, intraoperative complications, intraoperative conversion, postoperative bowel recovery, length of stay and postoperative complications. Suprapubic‐assisted laparoendoscopic single‐site surgery nephrectomy group had decreased postoperative analgesics (20.9 vs 23.5, P = 0.04), visual analog pain scale score at 24 h (4.28 vs 5.28, P = 0.000), visual analog pain scale score at discharge (1.01 vs 1.47, P = 0.000), days before going back to work (28.4 vs 31.9, P = 0.000) and Patient Scar Assessment Questionnaire score (34.0 vs 42.0, P = 0.000), compared with the standard laparoscopic nephrectomy group.ConclusionsSuprapubic‐assisted laparoendoscopic single‐site surgery nephrectomy and standard laparoscopic nephrectomy are equivalent in terms of the safety and efficacy. However, suprapubic‐assisted laparoendoscopic single‐site surgery nephrectomy confers less postoperative pain, fewer days before going back to work and better cosmetic result when compared with standard laparoscopic nephrectomy.

目的:总结腹腔镜辅助小切口“零缺血”巨大肾血管平滑肌脂肪瘤(renal angiomyolipoma,RAML)切除术的经验与体会,探讨其安全性和可行性.方法:回顾性分析2015年7月～2019年10月我院施行的9例腹腔镜辅助小切口“零缺血”巨大RAML切除术患者的临床资料.男4例,女5例;中位年龄43.7(36～78)岁;中位BMI 24.6(19.5～32.9) kg/m2;右肾3例,左肾6例;中位肿瘤最大径10.5(8.5～15.0) cm.其中1例合并胃间质瘤(直径2.0 cm).全麻.健侧70.卧位,于患侧脐缘置入一trocar,插入腹腔镜,于患侧肋缘下沿腹直肌旁分别置入2个trocar,间距约10 cm,插入操作器械.先在腹腔镜下游离肾脏及肾蒂,肿瘤周围暂不作游离.再取患侧腹直肌旁两trocar间小切口,必要时适当延长.直视下游离肾脏与肿瘤交界处,并用手指挤压正常肾实质,不阻断肾动脉,切除肿瘤并缝合创面,再将肿瘤周围游离后完整取出.合并胃间质瘤者,同期腹腔镜下一并处理.结果:本组9例手术均顺利完成.中位手术时间150(120～210) min,术中中位失血量220(150～350) mL,中位体表切口长径11.2(10.0～13.5) cm.均未输血,术中、术后均未发生严重并发症.所有患者术后恢复顺利,切口愈合良好.术后复查肾功能与术前无显著变化.术后中位视觉模拟疼痛评分(VAS)2(1～3)分,术后第1～2天即下床活动,术后第2～3天拔除腹腔引流管,术后第8天拆除切口缝线,中位术后住院时间8(6～9)d.术后病理均为肾血管平滑肌脂肪瘤.所有患者术后均获随访,中位随访时间26(2～53)个月,无肿瘤复发.结论:腹腔镜辅助小切口“零缺血”巨大RAML切除术安全、可行.该术式充分结合了腹腔镜和开放手术的优势,既最大程度保护了肾功能,又减少了手术创伤,值得临床应用.

目的:探讨钙敏感受体(calcium-sensing receptor,CaSR)基因多态性与江西赣南地区含钙肾结石(calcium nephrolithiasis,CN)的相关性.方法:采用实时荧光定量聚合酶链式反应(real-time polymerase chain reaction,Real-time PCR) TaqMan-MGB探针法检测赣南地区220例含钙肾结石患者(CN组)和250例健康人群(对照组)CaSR基因rs9740、rs1501899、rs3749207、rs4678174、rs6776158、rs7652589、rs1042636、rs1801725、rs1801726、rs7632399和rs9883981位点单核苷酸多态性(single nucleotide polymorphism,SNP),同时检测两组人群血钙和尿钙,应用R语言中SNPassoc 1.9-2和Haplo.stats 2.17.0软件分析CaSR基因型和单体型与含钙肾结石的相关性.结果:CN组中rs1501899位点的A等位基因频率高于对照组(P＜0.001);与对照组相比,CN组中rs1501899位点GG基因型频率显著增高(P＜0.001);CN组十对照组CaSR基因rs1501899 SNP位点GG型组尿钙(9.509±2.493) mg/dL显著高于AA型组(8.719±2.460) mg/dL (P=0.012)及AG型组(8.813±2.483)mg/dL(P =0.016).基因单体型分析显示,AATCAGAGCAA、AGCTGAGGCGG单体型与CN的形成呈正相关(OR=1.57,95％CI=1.46～1.69;OR =1.55,95％CI=1.46～1.64),AGCTAGGGCAA与CN的形成呈负相关(OR =0.87,95％CI=0.79～0.96).结论:CaSR基因多态性与江西赣南地区含钙肾结石的形成显著相关.

目的:探讨后腹腔镜下零缺血免缝合肿瘤吸除术治疗巨大肾错构瘤的安全性及可行性.方法:2018年4月～2019年6月我院应用后腹腔镜下零缺血免缝合肿瘤吸除术治疗3例巨大肾错构瘤.患者年龄分别为45岁、42岁、60岁,BMI分别为25.8 kg/m2、20.4 kg/m2、18.4 kg/m2.术前均通过彩超和CT等相关检查确诊为巨大肾错构瘤.全麻.于后腹腔镜下游离出肾动脉,以备必要时阻断.游离肾脏肿瘤,将吸引器深入瘤体进行抽吸,用超声刀切除肿瘤包膜及基底部组织,手术创面采用单极电凝Spray模式充分止血,对于难以吸除的成形瘤体装入标本袋取出.结果:3例手术均未阻断肾动脉,顺利完成.手术时间分别为90 min、100 min、125 min,估计出血量分别为300mL、700mL、700mL.1例患者术后接受输血治疗.术后住院时间分别为4d、7d、7d.无术后继发出血及尿漏等并发症发生.结论:后腹腔镜下零缺血免缝合肿瘤吸除术治疗巨大肾错构瘤安全可行,值得临床应用.

目的:比较超微经皮肾镜取石术(SMP)与微创经皮肾镜取石术(MPCNL)治疗上尿路结石的疗效,评价SMP治疗上尿路结石的价值.方法:收集49例SMP(SMP组)和同期49例MPCNL(MPCNL组)治疗上尿路结石患者的临床资料,比较两组手术时间、术后血红蛋白下降量、术后1d即时无石率、术后24 h视觉模拟疼痛评分(VAPS)、并发症发生率、住院时间及术后3个月无石率.结果:SMP组中44例成功施行SMP,5例因术中出血致视野不清改MPCNL(18F peer-away鞘)成功完成手术.MPCNL组中48例成功完成手术,1例因穿刺失败,终止手术,二期行软性输尿管镜碎石取石术(RIRS).SMP组较MPCNL组平均血红蛋白下降量低(8.3 g/Lvs.9.8 g/L,P=0.014)、全身炎症反应综合征(SIRS)发生率低(2.3％vs.4.2％,P=0.046)、无管化率高(93.2％vs.37.5％,P=0.012)、住院时间短(3.5 dvs.4.5d,P=0.035),但平均手术时间较长(70.5 min vs.58.6 min,P=0.023);术后并发症发生率(13.6％ vs.18.8％,P=0.158)、术后平均24 h VAPS评分(3.6分vs.4.1分,P=0.290),术后1d即时无石率(90.9％ vs.89.6％,P=0.131)、3个月后无石率(95.5％ vs.97.9％,P=0.084)比较差异无统计学意义.结论:SMP术中出血少、肾盂内压力低,术后并发症发生率低、恢复快、住院时间短,为上尿路结石的治疗提供了一个新的选择.

肾部分切除术(partial nephrectomy,PN)是保留肾单位手术(nephron sparing surgery,NSS)的主要术式.开放肾部分切除术(open partial nephrectomy,O-PN)已逐步被腹腔镜肾部分切除术(laparoscopic partial nephrectomy,L-PN)所取代,随着加速康复外科理念的深入和外科微创技术的发展,进一步减少手术创伤,减轻术后疼痛,达到更好的美容效果,以单孔腹腔镜手术(laparoendoscopic single-site surgery,LESS)和经自然腔道内镜手术(natural orifice transluminal endoscopic surgery,NOTES)为代表的一类“无瘢痕”手术应运而生.本文介绍了近年来肾部分切除术治疗肾癌的研究进展.

Objective: To describe the Chinese experience of natural orifice transluminal endoscopic surgery (NOTES) in urology. Methods: From December 2008 to May 2017, 35 animal experiments and 305 clinical surgeries of NOTES or natural orifices specimen extractions (NOSE) were performed in China. The animal experiments included five kidney biopsies, 24 nephrectomies and six partial nephrectomies. The clinical surgeries included 12 transvaginal NOSE (TV-NOSE), 266 hybrid transvaginal NOTES (TV-NOTES) and 27 pure TV-NOTES. The TV-NOSE procedure was performed in five transumbilical laparoendoscopic single-site (U-LESS) nephrectomies, four suprapubic-assisted laparoendoscopic single-site surgery (SA-LESS) nephroureterectomies, and three laparoscopic radical cystectomies. The hybrid TV-NOTES procedure included 210 nephrectomies, 31 adrenalectomies, eight nephroureterectomies, 13 partial nephrectomies, and four heminephrectomies. The pure TV-NOTES procedure included five renal cyst decortications and 22 nephrectomies. Results: A total of 29 animal experiments were successfully performed. One partial nephrectomy was converted to standard laparoscopic surgery. Two kidney biopsies and two nephrectomies were unsuccessful. A total of 297 clinical surgeries were successfully performed. Six patients who underwent hybrid TV-NOTES were converted to open surgery. Two patients who underwent pure TV-NOTES were converted to SA-LESS. There were 22 major complications, 16 occurred intraoperatively and six postoperatively. The mean visual analog score (VAS) of 48 h after the operation was 2.5 points in TV-NOSE, 2.3 points in hybrid TV-NOTES and 1.7 points in pure TV-NOTES. The mean follow-up of 50.6 (3.0-87.0) months showed that all patients were in good condition. The umbilicus scars were nearly invisible in TV-NOSE and hybrid TV-NOTES. The vaginal incision healed well. Conclusions: TV-NOSE and TV-NOTES are feasible, safe, and effective with little injury, low pain, fast recovery, and good cosmetic outcomes in properly selected patients. They are worth consideration for urological clinical practice. (C) 2020 Editorial Office of Asian Journal of Urology. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).