学习曲线内后腹腔镜输尿管上段切开取石术的手术难点探讨  

Investigation on the difficulties of retroperitoneal laparoscopic ureterolithotomy for upper ureteral calculi in learning curve

作　　者：李浩勇[1] 梁培育[1] 周治彦[1] 宋鹏[1] 许海波[1] 颜毅[1] 欧善际[1] 

机构地区：[1]海南医学院附属医院泌尿外科,海南海口570102

出　　处：《中国内镜杂志》2012年第7期752-755,共4页China Journal of Endoscopy

摘　　要：目的探讨学习曲线内后腹腔镜输尿管上段切开取石术的手术难点。方法 2007年7月～2010年12月由作者完成后腹腔输尿管上段切开取石术33例(男25例,女8例)。患者分为前期组(A组)16例和后期组(B组)17例。比较两组输尿管寻找、双J管的植入和输尿管缝合时间及手术并发症。结果两组患者结石平均大小相近([22.0±5.5):(20.0±5.0)mm,P>0.05],手术出血量相当。A组输尿管寻找时间([24.0±6.4):(10.0±3.7)min,P<0.05]、置入双J管时间(18.0±7.2):(8.0±3.7)min,P<0.05]、输尿管缝合时间([30.0±7.5):(13.0±3.6)min,P<0.05]和总手术时间([116.0±20.4):(72.0±12.2)min,P<0.05]显著多于B组。两组均无1例改行开放手术,A组1例双J管放置不到位发生漏尿,1例术后6个月发生输尿管狭窄。B组无1例并发症发生。结论输尿管结石的定位寻找和输尿管缝合、双J管的置入是学习后腹腔镜输尿管上段切开取石术的技术难点。后腹腔镜输尿管上段切开取石术学习曲线大约需15例左右经验积累,即可达到较熟练程度。[ Objective ] To investigate the difficulties of retroperitoneal laparoscopic ureterolithotomy （RLU） for upper ureteral calculi in learning curve. [Methods] Between July 2007 and December 2010, 33 cases （25 males and 8 females） consecutive retroperitoneal laparoscopic ureterolithotomies were reviewed by author during the learn- ing curve period in laparoscopy. Patients were divided and into group A （the first 16 patients） and group B （late 17 patients）. Timing for ureter isolation, ureteral double J stent placement and ureter suturing were recorded. Intraoper- ative complications and perioperative morbidity were also reported. [ Results ] There was no statistical difference in stone size between groups [（22.0±5.5） vs. （20.0±5.0） ram, P 〉0.05]. Significant differences between group A and B were observed in terms of time for access to the operating field [（24.0±6.4） and （10.0±3.7） rain, respectively, P 〈 0.05], time for double J ureteric stent placement [（18.0±7.2） and （8.0±3.7）rain, respectively, P 〈0.05], time for sutur- ing the ureter [（30.0±7.5） and （13.0±3.6） min, respectively, P 〈0.05]; and total operative time [mean times （116.0± 20.4） and （72.0±12.2） min, respectively, P 〈0.05]. No statistical differences were observed for any other parameters. Blood loss was minimal in all cases （mean losses 67 and 50 mL, respectively, P 〉0.05）; One patient developed urinary leakage because of displacement double J ureteric stent. At the 6-month follow-up, 1 cases of ureteral stricture were recorded in group A. [ Conclusions ] The operative difficulties were ureter isolation, ureteral double J stent placement and ureter suturing during the learning curve period in RLU. The learning curve of the RLU requires ap- proximately 15 cases to achieve more proficiency.

关 键 词：学习曲线 后腹腔镜 输尿管切开取石术 

分 类 号：R693.4[医药卫生—泌尿科学]