减少男性腹腔镜根治性膀胱切除术出血的规范化研究

发布时间：2018-03-06 00:25

本文选题：膀胱癌　切入点：腹腔镜根治性膀胱切除术　出处：《昆明医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：通过探讨减少腹腔镜根治性膀胱切除术(Laparoscopic Radical Cystectomy,LRC)出血的方法,并对现有手术方法进行改进,建立规范的手术操作流程,以缩短LRC的手术时间、减少术中出血、降低手术难度、缩短学习曲线,促进规范化LRC术式的推广和应用。方法：对2012年6月到20]4年1月昆明医科大学第二附属医院泌尿外科三病区的62例男性膀胱癌患者行经改良后的腹腔镜根治性膀胱切除术,具体方法为：游离输尿管；结扎髂内动脉脐动脉分支；游离膀胱、前列腺后间隙；标准法清扫盆腔淋巴结；切开盆内筋膜,游离前列腺的双侧面；结扎和切断膀胱后韧带和前列腺侧血管蒂；游离膀胱前间隙；缝扎耻骨前列腺韧带；游离、切断前列腺尖部尿道；逆行游离前列腺后壁。利用SPSS17.0软件对根治手术时间、术中出血量、淋巴结清扫数目进行统计分析,评价手术的疗效及安全性。结果：62例根治手术均在腹腔镜下成功完成,无中转开放手术。膀胱根治性切除术手术时间140-210min,平均170±19.5min:LRC术中出血量30ml-600ml,平均160±68.6ml；术中、术后无输血病例。术后组织病理检查示手术切缘全为阴性,盆腔淋巴结清扫数目4-21个,平均15.98±2.8个。围手术期无死亡病例,无直肠损伤、盆腔血管损伤病例。结论：通过对手术步骤的科学设计及操作方法的改进,可有效提高LRC手术质量、减少术中出血、降低手术并发症、缩短学习曲线。
[Abstract]:Objective: to study the method of reducing the bleeding of laparoscopic Radical cystectomy (LRC), and to establish a standard procedure of operation to shorten the operation time of LRC and reduce the bleeding during operation. To reduce the difficulty of operation, shorten the learning curve and promote the popularization and application of standardized LRC operation. Methods: from June 2012 to January, 62 male patients with bladder cancer were treated with modified laparoscopic radical cystectomy in the third ward of Urology, second affiliated Hospital of Kunming Medical University. The specific methods were as follows: free ureter; Ligation of umbilical artery branch of internal iliac artery; free bladder, posterior prostatic space; standard method for pelvic lymph node dissection; incision of intrapelvic fascia, bilateral side of free prostate; ligation and amputation of posterior bladder ligament and prostatic collateral vessel pedicle; Free anterior space of bladder; suture of pubic prostatic ligament; free, transected prostatic apical urethra; retrograde free prostatic posterior wall. SPSS17.0 software was used to analyze the time of radical operation, the amount of intraoperative bleeding, and the number of lymph nodes dissected. To evaluate the efficacy and safety of the operation. Results all of the 62 cases of radical resection were successfully performed under laparoscopy, and no conversion to open surgery was performed. The operative time of radical cystectomy was 140-210 min (mean 170 卤19.5 min) with an average bleeding volume of 30ml-600ml (160 卤68.6ml) during the operation. There were no blood transfusion cases after operation. The postoperative histopathological examination showed that the surgical margin was negative, the number of pelvic lymph node dissection was 4-21 (mean 15.98 卤2.8). There were no death cases, no rectal injury and pelvic vascular injury cases in perioperative period. Conclusion: through the scientific design of the operation steps and the improvement of the operation method, the quality of LRC operation can be improved effectively, the bleeding during operation can be reduced, the complications of operation can be reduced, and the learning curve can be shortened.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.14

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