三种不同方式的肾盂成形术治疗肾盂输尿管连接部梗阻的疗效分析

发布时间：2018-06-22 05:07

本文选题：肾盂输尿管连接处梗阻 + 机器人辅助腹腔镜肾盂成形术　；参考：《安徽医科大学》2017年硕士论文

【摘要】：[目的]探讨和比较分析三种肾盂成形手术方式(机器人辅助腹腔镜、传统腹腔镜和开放)对于治疗肾盂输尿管连接处梗阻(ureteropelvic junction obstruction,UPJO)的临床疗效。[方法]回顾性分析了2013年10月~2016年3月我院收治的肾盂输尿管连接处梗阻患者71例,以三种不同方式行肾盂成形术治疗,分别为机器人辅助腹腔镜(ro botic-assisted laparoscopic pyeloplasty,RALP)组16例,传统腹腔镜(laparoscop ic pyeloplasty,LP)组20例,开放式(open pyeloplasty,OP)组35例。观察比较三种方式的手术时间、术中出血量、肾周引流量及肾周引流管拔出天数、住院费用、住院天数、手术并发症情况以及术后肾积水复发等指标。全部统计分析采用SPSS 16.0统计软件进行统计分析,P0.05为差异有统计学意义。[结果]所有患者手术均成功完成,RALP及LP组无1例转为开放手术。RALP组平均手术时间为(72.69±16.78)min,平均出血量为(21.25±8.85)ml,平均肾周引流量为(30.94±12.94)ml,平均拔管天数为(2.63±0.72)天,平均住院天数为(4.19±0.91)天,平均住院费用为(46055.0±5181.1)元,RALP组术后出现1例泌尿系感染,1例肺部感染;LP组平均手术时间为(125.60±35.36)min,平均出血量为(52.50±27.60)ml,平均肾周引流量为(53.25±21.42)ml,平均拔管天数为(3.95±1.54)天,平均住院时间为(5.90±0.85)天,平均住院费用为(25134.0±7740.3)元,LP组出现3例泌尿系感染,1例漏尿;OP组平均手术时间为(127.40±42.64)min,平均出血量为(67.71±28.50)ml,平均肾周引流量为(74.86±37.43)ml,平均住院天数为(6.94±0.91)天,平均住院费用为(20384.0±6259.5)元,OP组术后出现3例泌尿系感染,2例漏尿,1例出血。三组术式的性别、年龄、体重指数、美国麻醉医生协会评分分级、发病位置对比差异无统计学意义(P0.05)。手术时间RALP组明显短于LP组和OP组,差异有统计学意义(P0.001);LP组和OP组差异无统计学意义。术中出血量、术后肾周引流量及拔管天数、术后住院天数、住院费用3组患者差异有统计学意义(P0.05)。LP组较OP组微创,术中出血量、术后肾周引流量及肾周引流管拔出天数、住院天数均减少,RALP组则将这些优势进一步扩大,但费用明显高于其他组。手术并发症3组患者无明显差异,均无严重并发症发生(P0.05)。3组患者术后随访2-31个月,通过定期行彩超、静脉肾盂造影(IVU)、泌尿系磁共振水成像(MRU)、肾图、核素动态肾脏显像(选择其中1至3项)检查,证实均未再发梗阻,肾盂积水均有不同程度减轻,分肾功能均有不同程度改善。[结论]与开放式的手术相比,腹腔镜的手术在安全性和可行性上并无显著的差异,但是腹腔镜的手术的优点在于术中出血少、创伤小和术后痛苦少、恢复快,将会是治疗肾盂输尿管连接部梗阻手术的发展趋势。而机器人辅助腹腔镜手术系统具有三维、放大的手术视野,从而可以让腹腔镜下复杂手术的难度降低,同时也可以减少手术当中对组织的副损伤,尤其对于组织和器官功能的重建手术更加适合。RALP组方式将逐渐替代LP组和OP组手术方式,可以让有条件的医院有了治疗UPJO的新选择。
[Abstract]:[Objective] to explore and compare the clinical effects of three types of pyeloplasty (robot assisted laparoscopy, traditional laparoscopy and opening) for the treatment of ureteropelvic junction obstruction (UPJO). [Methods] a retrospective analysis was made of the renal pelvis ureteral junction in our hospital in March, ~2016, October 2013. 71 cases of obstructive patients were treated with three different ways of renal pyeloplasty, 16 cases of RO botic-assisted laparoscopic pyeloplasty, RALP group, 20 cases of traditional laparoscopy (laparoscop IC pyeloplasty, LP), 35 cases of open (open pyeloplasty, OP) group. The operation time of three methods was compared and the operation time was observed and compared. Blood volume, peri renal flow rate and the number of days, hospitalization costs, days of hospitalization, complications of operation and recurrence of hydronephrosis after operation. All statistical analysis was made by statistical analysis of SPSS 16 statistical software. P0.05 was statistically significant. [results] the patients were successfully completed, and no 1 cases in group RALP and LP were transferred. The average operation time of the.RALP group was (72.69 + 16.78) min, the average bleeding amount was (21.25 + 8.85) ml, the average renal peritenal flow rate was (30.94 + 12.94) ml, the average extubation day was (2.63 + 0.72) days, the average hospitalization days were (4.19 + 0.91) days, the average hospitalization cost was (46055 + 5181.1) yuan. After RALP group, there were 1 cases of urinary tract infection and 21.25 lungs. The average operation time of the LP group was (125.60 + 35.36) min, the average bleeding volume was (52.50 + 27.60) ml, the average perirenal flow rate was (53.25 + 21.42) ml, the average extubation day was (3.95 + 1.54) days, the average hospitalization time was (5.90 + 0.85) days, the average hospitalization cost was (25134 + 7740.3) yuan, and the LP group had 3 cases of urinary tract infection and leakage of urine; OP group was flat. The average operation time was (127.40 + 42.64) min, the average bleeding amount was (67.71 + 28.50) ml, the average renal peritenal flow rate was (74.86 + 37.43) ml, the average hospitalization days were (6.94 + 0.91) days, the average hospitalization cost was (20384 + 6259.5) yuan (20384 + 6259.5), 3 urinary tract infection after operation, 2 cases of leakage of urine, 1 bleeding. There was no significant difference in the contrast of the incidence of the anesthesiologist Association (P0.05). The operation time RALP group was significantly shorter than the LP group and the OP group, and the difference was statistically significant (P0.001). There was no significant difference between the group LP and the OP group. The amount of intraoperative bleeding, the postoperative flow rate of the kidney and the number of extubation days, the days after the operation and the cost of the 3 groups of hospitalization expenses were different. Statistically significant (P0.05) group.LP was less invasive than group OP, intraoperative bleeding, postoperative flow rate of renal perirenin and the number of days of renal peripheral drainage tube pulling out, the number of days in hospital decreased, and the RALP group further expanded these advantages, but the cost was significantly higher than that of the other groups. The 3 groups of patients with complications of operation showed no serious complications (P0.05).3 group operation. After 2-31 months follow-up, through regular color Doppler ultrasound, intravenous pyelography (IVU), urography magnetic resonance hydrography (MRU), nephrography, and nuclide dynamic renal imaging (selection of 1 to 3 items), there was no further obstruction. The hydronephrosis was alleviated in varying degrees and the renal function was improved in varying degrees. [Conclusion] compared with open surgery, abdomen Endoscopic surgery has no significant differences in safety and feasibility, but the advantages of laparoscopic surgery are less bleeding, less trauma, less postoperative pain, and rapid recovery, which will be a trend in the treatment of ureteropelvic junction obstruction, and the robot assisted laparoscopic surgery system has a three-dimensional and magnified visual field. It can reduce the difficulty of complicated laparoscopic surgery and reduce the secondary injury to the tissue in the operation, especially for the reconstruction of tissue and organ function, which is more suitable for the.RALP group to replace the LP group and the OP group, which can allow the conditional hospital to have a new choice for the treatment of UPJO.
【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】：R699

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