机构地区:[1]第二军医大学长海医院泌尿外科,上海200433
出 处:《中华泌尿外科杂志》2012年第10期757-762,共6页Chinese Journal of Urology
基 金:上海市市级医院新兴前沿技术联合攻关项目(SHDCl2010115);军队l临床高新技术重大项目(2010gxjs057);上海市重点学科项目
摘 要:目的报道单中心209例泌尿外科单孔多通道腹腔镜手术,并评价其临床应用特点和价值。方法前瞻性收集2008年12月至2012年7月209例泌尿外科单孔多通道腹腔镜手术患者的临床资料和围手术期数据。男121例,女88例。年龄(52.8±14.5)岁。体质指数(body massin.dex,BMI)(23.5±3.1)kg/m。。既往腹盆腔手术史42例(20.1%)。麻醉评分(american society of an—esthesiologists score,ASA)(2.0±0.3)分。合并高血压61例(29.2%),糖尿病27例(12.9%)。术前诊断为。肾肿瘤70例(33.5%),肾上腺占位42例(20.1%),肾囊肿22例(10.5%),输尿管上段结石22例(10.5%),无功能肾脏19例(9.1%),BPH10例(4.8%),其他24例(11.5%)。探讨总体手术适应证、手术并发症和手术中转情况等临床特点,并将所有手术按完成时间先后分为两个阶段,每个阶段各22个月,进行相关参数的比较分析。结果本组共完成手术209例,其中上尿路手术193例(92.3%),肿瘤相关手术116例(55.5%),术中需重建的手术34例(16.3%),经腹腔途径手术169例(80.9%),经膀胱途径手术11例(5.3%),经脐切口手术98例(46.9%)。总体手术中转率8.1%(17/209),其中增加一个5或10mm辅助孔9例(4.3%),中转普通腹腔镜手术4例(1.9%),中转开放手术4例(1.9%)。总手术并发症发生率16.3%(34/209),术中并发症发生率4.8%(10/209),术后并发症发生率11.5%(24/209)。两个阶段比较分析显示,手术总量从第一阶段的77例上升到第二阶段的132例,平均每月完成手术量分别为(3.5±3.0)和(6.0±3.5)例,两组比较差异有统计学意义(P〈0.05)。第二阶段中肿瘤相关手术、根治性肾切除术和肾上腺切除术比例增高,经脐切口手术、肾�Objective To report a 4-year cumulative series (209 cases) of laparoendoscopic single- site surgery (LESS) in urology and assess its clinical utilization. Methods Consecutive LESS eases done between December 2008 and July 2012 at our institution were prospectively recorded and retrospective ana- lyzed in this study. Demographic data, main perioperative outcomes, and information related to the surgical technique were collected and analyzed. There were 209 patients ( 121 males and 88 females) with a mean age of ( 52.8 + 14.5 ) years, a mean BMI of (23.5 + 3.12) kg/m2 and a mean ASA score of (2.0 + 0.3 ).20.1% (42 cases) of patients had previous abdominal or pelvic surgeries. 29.2% (61 cases) and 12.9% (27 cases) of patients had diabetes mellitus and hypertension. Indications were renal tumors (70 cases, 33.5% ) , adrenal tumors (42, 20. 1% ) , renal cyst (22 cases, 10.5% ) , ureteral calculi (22 cases, 10.5%), nonfunctional kidneys (19 cases, 9. 1%), BPH (10 cases, 4.8%), and others (24 cases, 11.5% ). Surgical conversions were evaluated, as well as intraoperative and postoperative complications. Two periods were arbitrarily defined: the first was from December 2008 to September 2010 (22 mon) and the second was from October 2010 to July 2012 (22 mon). A comparative analysis between these two periods was conducted. Results There were 209 LESS surgeries included in this study. Most common procedures (92.3%) were done on the upper urinary tract, with 55.5% of the whole cohort being tumor-related indica- tions and only 16.3% being reconstructive procedures. The transperitoneal approaches were preferentially a- dopted in 80.9% cases, and transvesical access in 5.3% cases. The transumbilical access was used in 46.9% of cases. The overall conversion rate was 8. 1% , with 4.3% of cases converted to reduced -port laparoscopy, 1.9% to conventional laparoscopy, and 1.9% to open surgery. The intraoperativc complication rate was d. 8% (10/209�
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