三维腹腔镜与标准腹腔镜下肾部分切除术的对比研究

发布时间：2019-05-24 19:45

【摘要】：目的比较三维腹腔镜与标准腹腔镜下肾部分切除术的临床资料,探讨三维腹腔镜下肾部分切除术的安全性、可行性和优缺点。方法回顾性分析2012年1月—2015年3月收治的49例局限性肾肿瘤患者的临床资料,男31例、女18例,平均年龄为(55.5±12.5)岁,肿瘤位于左侧肾脏26例、右侧肾脏23例,手术入路为经腹腔途径16例、经后腹腔途径33例。根据手术方法将患者分为三维腹腔镜组(3D组,20例)和标准腹腔镜组(标准组,29例)。比较两组手术参与者的视觉满意度、操作适应度、头晕不适度、眼睛疲劳度评分。比较两组患者的手术时间、术中失血量、热缺血时间、术后肠道通气恢复时间、术后住院天数,以及两组术后1个月双侧肾脏肾小球滤过率(GFR)。结果两组手术均成功完成,无中转开放手术病例。3D组视觉满意度、操作适应度和总体满意度评分均显著高于标准组(P值均0.05),两组间头晕不适度和眼部疲劳度评分的差异均无统计学意义(P值均0.05)。两组间手术时间、术中失血量、术中热缺血时间、术后肠道通气恢复时间、术后住院天数和并发症发生率的差异均无统计学意义(P值均0.05)。两组术后随访4~41个月,无1例患者发生复发和转移。两组术后1个月患侧肾脏GFR均较术前显著降低(P值均0.05),健侧肾脏GFR均较术前显著升高(P值均0.05);两组间患侧和健侧肾脏手术前后GFR差值的差异均无统计学意义(P值均0.05)。结论应用三维腹腔镜技术行肾部分切除手术安全、可行;与标准腹腔镜相比,三维腹腔镜技术在视觉上和精细操作上可能具有一定的优势。
[Abstract]:Objective to compare the clinical data of three-dimensional laparoscopic partial renal resection with that of standard laparoscopic partial renal resection, and to explore the safety, feasibility, advantages and disadvantages of three-dimensional laparoscopic partial renal resection. Methods the clinical data of 49 patients with localized renal tumors from January 2012 to March 2015 were analyzed retrospectively. there were 31 males and 18 females with an average age of (55.5 卤12.5) years. The tumors were located in the left kidney in 26 cases and in the right kidney in 23 cases. The surgical approach was abdominal approach in 16 cases and posterior abdominal approach in 33 cases. According to the surgical method, the patients were divided into three-dimensional laparoscopy group (3D group, 20 cases) and standard laparoscopy group (standard group, 29 cases). The visual satisfaction, operation fitness, dizziness and eye fatigue were compared between the two groups. The operation time, intraoperative blood loss, warm ischemia time, postoperative intestinal ventilation recovery time, postoperative hospitalization days, and bilateral renal glomerular filtration rate (GFR). 1 month after operation were compared between the two groups. Results the operation was successfully completed in both groups. There were no cases of conversion to open surgery. Visual satisfaction, operation fitness and overall satisfaction score in 3D group were significantly higher than those in standard group (P 0.05). There was no significant difference in dizziness and eye fatigue score between the two groups (P 0.05). There were no significant differences in operation time, intraoperative blood loss, intraoperative warm ischemia time, postoperative intestinal ventilation recovery time, postoperative hospitalization days and incidence of complications between the two groups (P 0.05). The patients in the two groups were followed up for 4 months and 41 months, and no recurrence and metastasis occurred in none of the patients. One month after operation, the GFR of the affected side was significantly lower than that before operation, and the GFR of the healthy side was significantly higher than that before operation. There was no significant difference in GFR difference between the two groups before and after renal operation. Conclusion it is safe and feasible to use three-dimensional laparoscopy for partial resection of kidney, and compared with standard laparoscopy, three-dimensional laparoscopy may have some advantages in vision and fine operation.
【作者单位】：上海长征医院泌尿外科;上海长海医院泌尿外科;
【基金】：上海市科技人才计划(13XD1400100) 国家科技重大专项(2012ZX09303011-002) 国家自然科学基金面上项目(81272817,81172447) 上海市自然科学基金(11ZR1447800)项目资助
【分类号】：R737.11

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