Tisdale Britton E, Kapoor Anil, Hussain Abdullatif, Piercey Kevin, Whelan J Paul
Department of Urology, McMaster University, Hamilton, Ontario, Canada.
Urology. 2007 Feb;69(2):241-4. doi: 10.1016/j.urology.2006.09.061.
Laparoscopic nephrectomy is considered the standard of care for most Stage T1 and T2 renal tumors. Most centers perform intact extraction rather than morcellation. The extraction incision location varies, with no consensus on the best site. We compared the operative and perioperative parameters after transperitoneal laparoscopic nephrectomy procedures with intact specimen extraction through a Pfannenstiel (PFN) or expanded port site (EPS) incision.
The consecutive charts of 150 patients (March 2001 to October 2003) undergoing laparoscopic radical nephrectomy (LRN), laparoscopic nephroureterectomy, or laparoscopic donor nephrectomy with intact specimen extraction were reviewed. The specimens were extracted by way of a PFN or an EPS incision. Two analyses were completed. The first included only LRN, and the second included LRN, laparoscopic nephroureterectomy, and laparoscopic donor nephrectomy.
In the LRN-only analysis, the PFN group had a shorter hospital stay (2.84 versus 3.37 days, P <0.05). This group also used significantly less morphine (23.7 versus 47.3 mg, P <0.006). The PFN group in the second analysis also used less morphine (26.3 versus 51.1 mg, P <0.002). Four extraction site complications were found; 1 patient in the PFN group developed cellulitis, and 3 patients in the EPS group developed an incisional hernia.
This evidence suggests reduced morbidity with intact specimen extraction through a PFN incision compared with an EPS incision during laparoscopic nephrectomy procedures. Our practice has been modified on the basis of these data, and all specimens are now removed through a PFN incision when suitable. Urologists should consider PFN incisions for specimen extraction with laparoscopic nephrectomy procedures.
腹腔镜肾切除术被认为是大多数T1和T2期肾肿瘤的标准治疗方法。大多数中心采用完整取出而非粉碎术。取出切口位置各不相同，对于最佳部位尚无共识。我们比较了经腹膜腹腔镜肾切除术中通过耻骨上横切口（PFN）或扩大端口部位（EPS）切口完整取出标本后的手术及围手术期参数。
回顾了150例（2001年3月至2003年10月）接受腹腔镜根治性肾切除术（LRN）、腹腔镜肾输尿管切除术或腹腔镜供肾切除术并完整取出标本的患者的连续病历。标本通过PFN或EPS切口取出。完成了两项分析。第一项仅包括LRN，第二项包括LRN、腹腔镜肾输尿管切除术和腹腔镜供肾切除术。
在仅LRN的分析中，PFN组住院时间较短（2.84天对3.37天，P<0.05）。该组使用的吗啡也明显较少（23.7毫克对47.3毫克，P<0.006）。第二项分析中的PFN组使用的吗啡也较少（26.3毫克对51.1毫克，P<0.002）。发现4例取出部位并发症；PFN组1例患者发生蜂窝织炎，EPS组3例患者发生切口疝。
这一证据表明，与腹腔镜肾切除术中通过EPS切口完整取出标本相比，通过PFN切口取出标本可降低发病率。我们已根据这些数据改变了做法，现在所有合适的标本都通过PFN切口取出。泌尿外科医生在腹腔镜肾切除术中进行标本取出时应考虑采用PFN切口。
