经脐单孔腹腔镜半肾切除术与传统开放手术治疗儿童重复肾输尿管畸形的平行对照研究

发布时间：2019-06-11 19:44

【摘要】：研究目的:研究经脐单孔腹腔镜半肾切除术(Transumbilical Laparoendoscopic Single-Site Heminephroureterectomy,U-LESS-H)与传统开放半肾切除术(Conventional Open Heminephroureterectomy,C-H)相比较治疗儿童重复肾输尿管畸形的疗效与可行性、安全性,探讨单孔腹腔镜技术在治疗儿童重复肾输尿管畸形中的临床应用价值。研究方法:采用平行对照研究的方法,分析某儿童医院从2013年3月至2015年9月入组的采用半肾切除术治疗的儿童重复肾输尿管畸形患儿的临床数据。入院时以门诊单双号随机分入两组,并采用不同的手术方法。(1)单孔腹腔镜组:采用传统腹腔镜器械的经脐单孔腹腔镜半肾切除术(U-LESS-H);(2)开放手术组:经上腹部横切口的传统半肾切除手术(C-H)。统计患者的一般资料,围手术期数据,手术后中、短期疗效等方面的数据,进行统计学对比分析。研究结果:2013年3月至2015年9月共收治62例儿童重复肾输尿管畸形病例,经过筛选共有53例患儿应用半肾切除手术治疗的病例入组,另9例因为需要继续观察或采用其他手术方式予以排除。53例病例总体平均年龄35.8±36.8月。男21例,女32例。术前检查左侧31例,右侧14例,双侧8例。进行手术左侧36例,右侧16例,双侧1例。上半肾切除术52例,下半肾切除术1例。单孔腹腔镜组入组24例,平均年龄20.2±28.6月,男9例,女15例。开放手术组入组29例,平均年龄46.0±38.3月,男12例,女17例;两组性别组成、年龄和病变侧别等均衡性检验比较无统计学差异(P0.05)。单孔腹腔镜、开放手术两组伴随症状分别为:输尿管膨出(10:12例),输尿管反流(4:7例),输尿管异位开口(5:9例),反复尿路感染(7:8例)。单孔腹腔镜组有2例因出血各在下腹部增加一个额外套管,1例因出血中转开放手术。单孔腹腔镜、开放手术两组比较手术时间(167.3±43.7 min:137.0±28.8;P=0.006);术中出血量(23.2±43.7 ml:45.7±28.8 ml,P=0.134);输血(4:6例,P=0.709);术后恢复饮食时间(1.4±1.1 d:1.4±1.5 d,P=0.785);留置引流管时间(4.1±2.0 d:5.1±1.6 d,P=0.200);术后住院时间(8.6±2.2 d:8.6±2.0 d,P=0.725)。术后平均随访18.2月(2~31月),单孔腹腔镜、开放手术两组发热尿路感染(3:2例,P=0.824);高血压(0:2例,P=0.495);输尿管残端综合症(1:3例,P=0.745);尿囊肿(1:0例,P=0.453);下肾功能丧失(0:1,P=1.000)。研究结论:(1)经脐单孔腹腔镜半肾切除术(U-LESS-H)是安全、简便、有效的。(2)U-LESS-H可以达到C-H的手术效果。(3)在手术创伤和美容效果上U-LESS-H较CH的优势更加明显。
[Abstract]:Objective: To study the efficacy and feasibility and safety of transumbilicus single-port laparoscopic half-nephrectomy (U-LESS-H) compared with conventional open heminephelus (C-H). To evaluate the clinical value of single-hole laparoscopic technique in the treatment of children with reduplication of the ureter. Methods: The clinical data of a children's hospital from March 2013 to September 2015 were analyzed by means of a parallel-control study. The two groups were randomly divided into two groups at the time of admission, and different methods of operation were used. (1) Single-hole laparoscopic group: an umbilical single-hole laparoscopic half-nephrectomy (U-LESS-H) with a conventional laparoscopic instrument; and (2) an open-operation group: a conventional semi-nephrectomy procedure (C-H) with a transabdominal transection. Statistical analysis was performed on the data of general data, perioperative data, post-operative, short-term efficacy, and so on. Results: From March 2013 to September 2015, a total of 62 cases of repeated renal and ureteral malformation were treated, and a total of 53 cases were enrolled in the treatment of half-nephrectomy. Another 9 cases were excluded because of the need to continue to observe or to use other surgical methods. The overall mean age of 53 cases was 35.8 to 36.8 months. There were 21 males and 32 females. There were 31 cases on the left,14 in the right and 8 on the left side. The left side of the operation was 36 cases, right side 16 cases, bilateral 1 case. There were 52 cases of upper half-nephrectomy and one case of lower half-nephrectomy. There were 24 cases of single-hole laparoscopic group, with average age of 20.2-28.6 months,9 male and 15 female. The average age was 46.0 and 38.3 months, with the average age of 46.0 and 38.3 months. There was no statistical difference between the two groups (P0.05). The combined symptoms of single-hole laparoscopic and open operation were ureterocele (10:12), ureteral reflux (4:7 cases), ectopic opening of the ureter (5:9 cases), and repeated urinary tract infection (7:8 cases). In the single-hole laparoscopic group,2 cases increased an extra cannula in the lower abdomen due to the bleeding, and one case was transferred to the open operation due to the hemorrhage. The operative time (167.3-43.7 min: 137.0-28.8, P = 0.006) was compared between the two groups. The intraoperative blood loss (23.2% 43.7 ml: 45.7-28.8 ml, P = 0.134), blood transfusion (4:6, P = 0.709), and post-operative recovery of the dietary time (1.4-1.1 d: 1.4-1.5 d, P = 0.785); The time of the indwelling drainage tube (4.1-2.0 d: 5.1-1.6d, P = 0.200), the post-operative hospital stay (8.6% 2.2d: 8.6-2.0 d, P = 0.725). The postoperative mean follow-up was 18.2 months (2-31 months), single-port laparoscopic, open-operation two groups of fever urinary tract infection (3:2, P = 0.824), hypertension (0:2, P = 0.495), ureteral stump syndrome (1:3, P = 0.745), urinary cyst (1:0, P = 0.453), and lower renal function (0:1, P = 1.000). Conclusion: (1) The laparoscopic partial nephrectomy (U-LESS-H) is safe, simple and effective. (2) U-LESS-H can achieve the effect of C-H. (3) The advantage of U-LESS-H is more obvious in the surgical and cosmetic effects.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.9

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