手助腹腔镜肾癌根治术中肾血管的处理：切割吻合器还是威克结扎锁？

发布时间：2018-06-19 16:58

本文选题：手助腹腔镜 + 肾切除　；参考：《山东大学》2014年硕士论文

【摘要】：目的：探讨手助腹腔镜中使用腔内直线切割吻合器(Endo GIA)和威克外科结扎锁(Hem-O-lok)截断肾血管的安全性及经济性。材料及方法：本次研究我们回顾性的分析了山东省立医院泌尿微创肾移植科自2010年1月至2013年9月共49例接受手助腹腔镜肾癌根治术的患者资料。27-72岁,平均年龄52.6±10.6岁；左侧病变27例,右侧22例,均经B超及强化CT检查诊断为肾癌,其中2例合并肾静脉癌栓。49例患者均采用经腹腔的手助腹腔镜肾癌根治术,根据术中处理肾蒂方法的不同,我们将49例患者分为：A组：使用腔内直线切割吻合器同时截断肾动、静脉(21例)；B组：威克外科结扎锁分别截断肾动、静脉(28例,肾静脉癌栓2例)。统计所有病例术中及围手术期的相关数据,并对住院期间相关费用进行统计分析,评估Endo GIA和Hem-0-lok的安全性及经济性。结果： 49例手术过程均顺利,无中途转开放手术,术中及术后无明显血管并发症,B组2例肾静脉癌栓患者均在术中成功取栓。两组术中平均出血分别为78.3ml和92.1ml(P=0.244),手术平均时间分别为75.7min和94.1min(P=0.059),术后平均住院天数分别为7.52d和7.29d(P=0.761),术后第一日引流量平均值分别为145.76ml和172.54ml(P=0.143),均无显著性差异。术后前三日引流量分别为282.67ml和403.35ml(P=0.018),所用耗材费用平均值分别为3651.90元和2781.43元(P=0.008)有显著性差异。结论：手助腹腔镜肾切除术中用腔内直线切割吻合器(Endo GIA)和威克外科结扎锁(Hem-O-lok)处理肾蒂血管安全性均较可靠。但使用Hem-O-lok对周围组织损伤较切割吻合器大,术者需要根据经验进行精细处理。对于有经验的外科医师使用Hem-O-lok则更经济,是不错的选择。
[Abstract]:Objective: to investigate the safety and economy of endolumbar wire incision stapling (Endo GIAA) and surgical ligation of Hem-O-lok (Hem-O-lok) in hand-assisted laparoscopy. Materials and methods: in this study, we retrospectively analyzed the data of 49 patients undergoing hand-assisted laparoscopic radical nephrectomy from January 2010 to September 2013 in the Department of Urology and minimally invasive Kidney Transplantation, Shandong Provincial Hospital. The mean age was 52.6 卤10.6 years, the left lesions were 27 cases, the right side 22 cases, all of them were diagnosed as renal cell carcinoma by B-ultrasound and enhanced CT, among them, 2 cases were complicated with renal vein carcinoma thrombus. 49 cases were treated with intraperitoneal hand-assisted laparoscopic radical nephrectomy. According to the different methods of dealing with renal pedicle during operation, 49 cases were divided into two groups: group A (n = 28), group B (n = 21) treated with intracavitary straight wire incision stapler and group B (n = 21): the renal artery was truncated by surgical ligation lock, and 28 cases by vein anastomosis. Renal vein tumor embolus in 2 cases. To evaluate the safety and economy of Endo GIA and Hem-0-lok, the relevant data of all cases during operation and perioperative period were analyzed. Results: the procedure of 49 cases was smooth, there was no midway to open operation. In group B, 2 patients with renal vein tumor thrombus were successfully removed during the operation without obvious vascular complications. The average intraoperative bleeding was 78.3ml and 92.1ml / L Pu 0.244g, the average operation time was 75.7min and 94.1min P0. 059m respectively, the average hospitalization days were 7.52 days and 7.29days respectively. The average drainage volume on the first day after operation was 145.76ml and 172.54mlP0.143, respectively. There was no significant difference between the two groups. For the first three days after operation, the drainage volume was 282.67ml and 403.35 ml / L, respectively, and the average cost of the consumables was 3651.90 yuan and 2781.43 yuan respectively. There was significant difference between the two groups. Conclusion: Endo GIAs and Hem-O-lok in hand-assisted laparoscopic nephrectomy are safe for the treatment of renal pedicle vessels. But using Hem-O-lok to injure the surrounding tissue is more serious than cutting stapler, so the operator needs to deal with it carefully according to experience. Hem-O-lok is more economical and a good choice for experienced surgeons.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.11

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