单孔腹腔镜手术在泌尿外科中的临床应用及并发症分析

发布时间：2018-06-09 20:30

本文选题：单孔腹腔镜手术 + 泌尿外科　；参考：《延边大学》2017年硕士论文

【摘要】：目的:分析单孔腹腔镜手术在泌尿外科中的临床应用及并发症情况,为泌尿外科的患者选择安全和有效的治疗技术提供参考依据。方法:选取2014年9月至2016年9月在廊坊市人民医院接受腹腔镜下手术的泌尿外科患者98例,其中26例行肾肿瘤根治术,24例行输尿管切开取石术,48例行肾囊肿去除术。全部患者分为观察组(单孔腹腔镜)49例,对照组(传统腹腔镜)49例。观察各组患者的手术时间、切口大小、术中出血量、手术时气道压强均值、术后移除气管导管时间、术后Hb下降幅度、术后住院天数、视觉模拟评分(VAS)、术后并发症系统分级及皮下气肿发生率。结果:1)两组肾肿瘤根治术患者手术时间、切口大小、术中出血量、术后Hb下降幅度、术后住院天数、视觉模拟评分及术后并发症系统分级均无统计学差异(P0.05)。观察组手术时气道压强均值为(21.32±3.87)cmH2O,明显低于对照组的(27.98±4.67)cmH20;术后移除气管导管时间(19.79±2.36)min,明显低于对照组的(34.23±3.11)min,皮下气肿发生率为15.38%,低于对照组的30.77%,均具有统计学差异(P0.05)。2)两组输尿管切开取石术患者手术时间、术中出血量、术后Hb下降幅度、术后住院天数、视觉模拟评分及术后并发症系统分级均无统计学差异(P/0.05)。观察组的切口大小为(1.83±0.31)cm,明显小于对照组的(3.15±0.52)cm;手术时气道压强均值为(18.77±2.25)cmH2O,明显低于对照组的(23.92±4.13)cmH2O;术后移除气管导管的用时(15.36±3.78)min,明显低于对照组的(34.23±4.67)min;皮下气肿发生率为8.33%,低于对照组的33.33%,均具有统计学差异(P0.05)。3)两组肾囊肿去除术患者手术时间、术中出血量、术后Hb下降幅度、术后住院天数、视觉模拟评分及术后并发症系统分级均无统计学差异(P0.05)。观察组的切口大小为(1.46±0.54)cm,明显小于对照组的(3.02±0.67)cm;手术时气道压强均值为(17.89±2.47)cmH2O,明显低于对照组的(21.95±3.35)c,H2O;手术后移除气管导管的用时(24.68±7.99)min,明显低于对照组的(44.23±4.82)min;皮下气肿发生率为0,低于对照组的16.67%,均具有统计学差异(PP0.05)。结论:单孔腹腔镜下泌尿外科手术安全可靠,并且能够降低皮下气肿发生率,减小患者的气道受损的可能,减短麻醉苏醒用时,同时还能提高美观性,具有较好的治疗效果,有一定的临床应用价值,值得推广。
[Abstract]:Objective: to analyze the clinical application and complications of single hole laparoscopic surgery in the Department of urology. To provide a reference basis for selecting safe and effective treatment techniques for patients in the Department of urology. Methods: 98 cases of patients received laparoscopic hand surgery in Langfang People's Hospital from September 2014 to September 2016 were selected, of which 26 were treated with nephrectomy. Radical resection of the tumor, 24 cases of ureterolithotomy and 48 cases of renal cyst removal were performed. All the patients were divided into the observation group (single hole laparoscope) 49 cases and the control group (traditional laparoscopy) 49 cases. The operation time, the size of the incision, the amount of bleeding during the operation, the mean airway pressure in the operation, the time of the tracheal catheter removal after operation, and the decrease of Hb after the operation were observed. Postoperative hospital days, visual analogue scale (VAS), postoperative complications system classification and subcutaneous emphysema incidence. Results: 1) two groups of renal tumor radical operation time, incision size, intraoperative bleeding, postoperative Hb decline, postoperative hospital days, visual analogue evaluation and postoperative complications system classification were no significant difference (P0.05). The mean airway pressure of the group was (21.32 + 3.87) cmH2O, which was significantly lower than that of the control group (27.98 + 4.67) cmH20, and the time of tracheal catheter removal (19.79 + 2.36) min after operation was significantly lower than that of the control group (34.23 + 3.11) min, and the incidence of subcutaneous emphysema was 15.38%, lower than 30.77% of the control group (P0.05).2) and the two ureterotomy was taken. The operation time, intraoperative bleeding, postoperative Hb decline, postoperative hospital stay, visual analogue scale and postoperative complications system classification were not statistically different (P/0.05). The incision size of the observation group was (1.83 + 0.31) cm, obviously less than that of the control group (3.15 + 0.52) cm; the mean airway pressure in the operation was (18.77 + 2.25) cmH2O, obviously lower. In the control group (23.92 + 4.13) cmH2O, the removal of tracheal catheter after operation (15.36 + 3.78) min was significantly lower than that of the control group (34.23 + 4.67) min; the incidence of subcutaneous emphysema was 8.33%, lower than 33.33% of the control group, and all had statistical difference (P0.05).3) the operation time, the amount of intraoperative hemorrhage, and the decrease of Hb after operation in the two group of renal cysts were performed. The postoperative hospital days, visual analogue scale and postoperative complications system classification were not statistically different (P0.05). The incision size of the observation group was (1.46 + 0.54) cm, obviously less than that of the control group (3.02 + 0.67) cm, and the mean airway pressure was (17.89 + 2.47) cmH2O during the operation, which was significantly lower than that of the control group (21.95 + 3.35) C, H2O; the use of tracheal catheter after operation The rate of (24.68 + 7.99) min was significantly lower than that of the control group (44.23 + 4.82) min, and the incidence of subcutaneous emphysema was 0, which was lower than 16.67% of the control group (PP0.05). Conclusion: the single hole laparoscopic Department of Urology operation is safe and reliable, and it can reduce the incidence of subcutaneous emphysema, reduce the possibility of airway damage in the patients, and reduce the use of anesthesia recovery. At the same time, at the same time, it can also improve the beauty, has good therapeutic effect, has certain clinical application value, and is worthy of promotion.
【学位授予单位】：延边大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R699

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