腹膜后改良穿刺位点治疗84例肾脏疾病报告  

The experience of treating 84 patients with different kidney diseases using modified retroperitoneoscopic puncture site

作　　者：胡东亮[1] 王行环[1] 胡万里[1] 张卫兵[1] 倪栋[1] 

机构地区：[1]武汉大学中南医院泌尿外科,武汉430071

出　　处：《微创泌尿外科杂志》2013年第6期371-373,共3页Journal of Minimally Invasive Urology

基　　金：国家自然科学基金资助项目(81200579)

摘　　要：目的:介绍应用改良腹膜后穿刺位点行后腹腔镜肾脏手术的经验与总结。方法:收集84例不同肾脏疾病患者,其中男41例,女43例,平均年龄(45.6±11.8)岁。右侧46例,左侧38例。针对不同疾病及标本大小,设计了3种改良的腹膜后切口,分别命名为:M1,M2和M3,不同疾病患者选择与之适应的改良切口进行后腹腔镜手术,同时选择75例对照组行传统穿刺位点的后腹腔镜手术。结果:83例患者应用腹膜后改良穿刺位点顺利完成后腹腔镜手术,仅1例改为开放手术。平均手术时间(72±18)min,术中预估出血量(29±11)ml,术后无重大并发症和死亡。在改良术式的选择上,乳糜尿、无功能积水肾、肾囊肿患者全部通过M1法完成,仅有6例巨大的肾癌患者通过M3法完成手术。其余52例肾脏良恶性肿瘤中,19例通过M2法完成,33例仍然通过M1法完成。对比各项手术指标,其中M1和M2方式的术后美观评分高于传统腹腔镜组,M1(8.9±2.2),M2(8.7±2.5),传统腹腔镜(7.3±2.8)(P<0.05);改良组的双氯芬酸钠使用量小于传统组(50∶100mg,P<0.05),其余指标差异无统计学意义。结论:改良的腹膜后穿刺位点可以满足不同肾脏疾病的手术,具有美观和个性化的特征。Objective:To introduce our experience in using modified retroperitoneoscopic puncture site for the operation of kidney diseases.Methods:We admitted 84cases who had different kidney diseases(41male and 43female patients,46on the right side and 38on the left side,mean age(45.6±11.8)years.We designed three modified incisions according to different surgeries and specimen size and named them as follow:M1,M2and M3.Different patients could choose corresponding modified incisions for their retroperitoneoscopic surgery.The clinical data were compared with those of 75patients who had undergone the same or similar procedures using classical 3-port incisions.Results:Of the 84patients,83cases were underwent retroperitoneoscopic kidney surgery using modified puncture site.Only 1case required open conversion.The mean operative time was(72±18)min and average blood loss was(29±11)ml.No serious postperative complications and death were observed.To the choice of modified incisions,patients with chyluria,nonfunctional or atrophic kidney and renal cyst were finished by M1method,and only 6cases with huge renal carcinoma were finished by M3method.Of the rest 52cases with renal tumor,19cases were completed by M2method,and 33cases were still completed by M1method.A significant difference in favor of modified group was noted with respect to analgesia use in all three modified methods(diclofenac sodium,50∶100mg,P <0.05)and cosmetic outcome(score,8.9±2.2∶7.3±2.8,P<0.05)in M1and M2method(score,8.7±2.5∶ 7.3±2.8,P<0.05).Conclusions:Our modified retroperitoneoscopic puncture sites have more cosmetic and individual advantage and meet different kidney surgeries.

关 键 词：腹腔镜 后腹腔 肾脏疾病 切口 改良方式 

分 类 号：R692[医药卫生—泌尿科学]