后腹腔镜下肾部分切除术治疗中央型及外周型肾肿瘤的临床对比研究

发布时间：2018-03-18 11:14

  本文选题：中央型肾肿瘤　切入点：后腹腔镜下肾部分切除术　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的目前外周型肾肿瘤采用腹腔镜下肾部分切除术治疗已经在临床广泛地开展,而中央型肾肿瘤由于位置深并且靠近肾蒂血管和集合系统,手术难度相对较大,对腹腔镜肾部分切除技术要求高,在现阶段仍是一项充满技术挑战性的手术。经后腹腔途径的腹腔镜肾部分切除术在手术持续时间、手术出血量和手术并发症方面有较大的优势,因此我们分析后腹腔镜下肾部分切除术治疗中央型肾肿瘤的安全性和可行性。资料与方法我们收集了 2014年12月到2016年6月期间在山东大学齐鲁医院泌尿外科行后腹腔镜下肾部分切除术的患者资料。将61例按标准纳入研究对象,其中中央型肾肿瘤患者10例,外周型肾肿瘤患者51例。对比研究采集的信息:患者性别、年龄、体重指数、ASA分级、热缺血时间、手术时间、术中出血量、肿瘤位置、肿瘤病理直径、肿瘤病理类型、肿瘤的Fuhrman分级、围手术期并发症、术前血清肌酐、术后血清肌酐、肾小球滤过率下降等,并通过问卷评分的方式评估了手术医师工作负荷、技术操作难度、表现满意度、时间压力以及配合手术护理人员的工作负荷等各指标。采用SPSS 22.0统计软件对数据进行统计分析。使用Kolmogorov-Smirnov方法检验计量数据的正态性,如果计量数据呈现正态分布趋势,则使用独立样本t检验。有序变量或者不符合正态分布的数据,采用Mann-Whitney U秩和检验,无序分类变量使用卡方检验或者Fisher确切概率法检验,以P0.05为差异有统计学意义。结果两组患者的年龄、体重指数、性别等术前资料均无差异统计学意义。61例手术均在全麻下顺利完成,术中没有手术方式的转换。中央型肾肿瘤组的平均手术时间175.0±23.2min,热缺血时间25.8±3.0min,失血量97.9±22.8ml;术后并发症ClavienⅠ级2例,肾小球滤过率下降百分数为9.5±7.1%。外周型肾肿瘤组的平均手术时间139.7±30.6min,热缺血时间19.1±3.9min,失血量91.6±66.1ml,术后并发症ClavienⅠ级9例、Ⅱ级2例,肾小球滤过率下降百分数为5.9±11.2%。两组在手术时间和手术热缺血时间比较有差异统计学意义,中央型肾肿瘤组的手术时间和热缺血时间均显著长于外周型肾肿瘤组。在手术中失血量、肿瘤最大直径、术后肿瘤病理类型、肿瘤Furman分级、术后并发症、肾小球滤过率下降上比较均无差异统计学意义。对手术者而言,中央型肾肿瘤组的工作负荷要明显高于外周型肾肿瘤组(3.10±0.74 vs.2.12±0.79),中央型肾肿瘤组的技术操作难度要明显高于外周型肾肿瘤组(3.10±0.57 vs.2.37±0.75);而在表现满意度和时间压力上两组之间均无明显差异。对护理人员而言,两组在工作负荷上无显著差异。结论我们认为后腹腔下肾部分切除术治疗中央型肾肿瘤是一种安全有效的手术方式,值得在临床上推广应用。
[Abstract]:Objective Laparoscopic partial nephrectomy has been widely used in the treatment of peripheral renal neoplasms, while central renal tumor is difficult because of its deep location and close to the renal pedicle vessels and collecting system. Laparoscopic partial nephrectomy is a technically challenging procedure at this stage. Laparoscopic partial nephrectomy via retroperitoneal approach lasts for a long time. The amount of blood lost and the complications of the operation have great advantages. Therefore, we analyzed the safety and feasibility of retroperitoneal laparoscopic partial nephrectomy in the treatment of central renal neoplasms. Data and methods We collected the urological department of Qilu Hospital, Shandong University from December 2014 to June 2016. Data of patients undergoing retroperitoneal laparoscopic partial nephrectomy. 61 patients were included in the study according to the criteria. There were 10 patients with central renal tumor and 51 patients with peripheral renal tumor. The information collected from the comparative study was as follows: gender, age, body mass index (BMI) ASA grade, warm ischemia time, operative time, intraoperative bleeding volume, tumor location. Tumor pathological diameter, tumor pathological type, tumor Fuhrman grade, perioperative complications, preoperative serum creatinine, postoperative serum creatinine, decreased glomerular filtration rate, etc. The technical operation difficulty, performance satisfaction, time pressure and workload of nursing staff were analyzed with SPSS 22.0 software. Kolmogorov-Smirnov method was used to test the normality of measurement data. If the measurement data show a trend of normal distribution, then the independent sample t test is used. The ordered variables or data that do not conform to the normal distribution are tested by Mann-Whitney U rank sum test, the unordered classification variables are tested by chi-square test or Fisher exact probability test. Results there was no significant difference in age, body mass index, sex and other preoperative data between the two groups. 61 cases of operation were successfully completed under general anesthesia. There was no change of operative mode during the operation. The mean operative time, hot ischemia time and blood loss were 175.0 卤23.2min, 25.8 卤3.0min, 97.9 卤22.8 ml, respectively, and the postoperative complications were Clavien 鈪，

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