3D腹腔镜与传统腹腔镜在肾部分切除术中的临床应用研究

发布时间：2018-11-29 13:26

【摘要】：背景和目的随着学科的发展,保留肾单位手术的疗效已被认可,且较广泛的应用于临床,目前腹腔镜已成为当下流行的手术方法,其中3D腹腔镜为近年来比较火热的话题,而将其应用于保留肾单位的手术中,其优劣势如何,各家数据不尽相同,因此对3D腹腔镜及传统腹腔镜在保留肾单位手术行对比研究,比较其疗效及使用价值。方法回顾性分析我院2013年8月至2016年12月收治的42例肾肿瘤行腹腔镜保留肾单位手术的临床资料,其中3D腹腔镜组22例和传统腹腔镜组20例。2组患者年龄、性别、肿瘤左右侧、肿瘤大小均无统计学差异。分析比较二组临床资料的手术时间、热缺血时间、术中出血量、住院费用和并发症发生情况。结果二组手术均成功顺利完成,无一例中转开放手术者。传统组和3D组的手术时间分别为(125.70±9.30)min、(111.55±9.05)min,差异有统计学意义(P0.05);热缺血时间分别为(29.45±5.53)min、(26.14±4.57)min,差异有统计学意义(P0.05);住院费用分别为(1.93±0.11)万元、(1.99±0.12)万元,差异无统计学意义(P0.05);术中出血量分别为(97.90±9.07)ml、(91.73±10.68)ml,差异无统计学意义(P0.05);2组均有1例切口延迟愈合,保守治疗后均治愈。术后病理示:所有手术切缘均阴性;手术标本中透明细胞癌31例,血管平滑肌脂肪瘤8例,囊性肾细胞癌1例,嫌色细胞癌2例。随访6~48个月,未见复发和转移,肾功能检查未见异常。结论二组手术方式在保留肾单位手术上都是安全有效的微创术式。传统腹腔镜推广简单,投入费用少,应用广泛;3D腹腔镜在空间定位及深度感上有明显的三维优势,其立体视野使得游离、缝合等手术操纵更易于进行,同时有着可观的经济性,使其在泌尿外科手术领域有着广阔的应用前景。
[Abstract]:Background and objective with the development of science, the curative effect of nephron sparing surgery has been recognized, and widely used in clinical practice. At present, laparoscopy has become a popular surgical method, among which 3D laparoscopy is a hot topic in recent years. However, the merits and demerits of renal unit sparing surgery are different from each other. Therefore, a comparative study of 3D laparoscopy and traditional laparoscopy in renal unit sparing surgery is carried out to compare the curative effect and practical value. Methods the clinical data of 42 patients with renal tumor undergoing laparoscopic nephron-sparing surgery from August 2013 to December 2016 were retrospectively analyzed, including 22 cases in 3D laparoscopic group and 20 cases in traditional laparoscopic group. There was no significant difference in tumor size between the right and left sides. The time of operation, the time of hot ischemia, the amount of intraoperative bleeding, the cost of hospitalization and the occurrence of complications were analyzed and compared between the two groups. Results all the operations were successfully completed in both groups, none of them were transferred to open operation. The operative time of traditional group and 3D group were (125.70 卤9.30) min, (111.55 卤9.05) min, significantly different (P0.05). The time of hot ischemia was (29.45 卤5.53) min, (26.14 卤4.57) min, (P0.05). The hospitalization expenses were (1.93 卤0.11) yuan and (1.99 卤0.12) yuan, respectively. The difference was not statistically significant (P0.05). There was no significant difference in intraoperative bleeding volume (97.90 卤9.07) ml, (91.73 卤10.68) ml, (P0.05). All the surgical margins were negative, 31 cases of clear cell carcinoma, 8 cases of angiomyolipoma, 1 case of cystic renal cell carcinoma and 2 cases of chromophobe cell carcinoma. Follow-up for 6 ~ 48 months showed no recurrence or metastasis and no abnormal renal function. Conclusion both groups are safe and effective minimally invasive procedures for nephron-sparing surgery. The traditional laparoscopy is simple to popularize, has less input cost and is widely used. 3D laparoscopy has obvious advantages in spatial location and depth sense, and its stereoscopic visual field makes free, suture and other surgical manipulation easier, and has considerable economy. It has a broad application prospect in the field of urological surgery.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.11

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