单孔与标准腹腔镜下无功能肾切除术的临床疗效对比  

Standard laparoscopic vs laparoendoscopic single-site nephrectomy for benign nonfunctioning kidney:a comparison of therapeutic outcomes

作　　者：叶学荣 刘冰[1] 曲乐[1] 宋尚卿[1] 王志向[1] 鲍一[1] 李鹏[1] 王林辉[1] 孙颖浩[1] 

机构地区：[1]第二军医大学长海医院泌尿外科,上海200433

出　　处：《第二军医大学学报》2014年第10期1151-1155,共5页Academic Journal of Second Military Medical University

基　　金：国家自然科学基金(81172447);上海市自然科学基金(11ZR1447800)~~

摘　　要：目的对比经脐单孔多通道腹腔镜与标准经腹腹腔镜下行无功能肾切除术的临床疗效。方法 2009年9月至2013年8月,本单位同一手术组完成无功能肾切除微创手术72例,其中50例行标准经腹腹腔镜手术,22例行经脐单孔多通道腹腔镜手术,回顾性分析两组患者的临床资料,比较临床疗效。结果 72例手术均获成功,无中转开放手术。标准腹腔镜组、经脐单孔多通道腹腔镜组术后疼痛评分(4.3±1.0vs 3.7±0.8,P=0.015)、术后肠通气恢复时间[(58.1±16.1)h vs(49.2±14.0)h,P=0.032)]、术后留置引流管时间[(3.9±1.5)d vs(2.8±1.1)d,P=0.003)]、术后住院时间[(7.3±3.1)d vs(6.3±3.4)d,P=0.048]、手术切口满意度(7.4±0.9vs 8.0±0.6,P=0.001)差异均有统计学意义。两组手术时间、术中出血量差异无统计意义。结论与标准经腹腹腔镜下无功能肾切除术相比,经脐单孔腹腔镜手术具有术后疼痛轻、肠道通气恢复快、引流管拔除时间早、切口满意度高的优势,但远期疗效仍有待观察。Objective To compare the therapeutic outcomes of standard laparoscopic and laparoendoscopic single-site（LESS）nephrectomy for benign nonfunctioning kidney.Methods From September 2009 to August 2013,a single urologist group in our center performed 72 transperitoneal laparoscopic nephrectomies for benign nonfunctioning kidney,with 50 undergoing LESS（group A）and 22 undergoing standard laparoscopic surgery（group B）.The clinical data of the two groups were analyzed and the therapeutic outcomes were compared between the two groups.Results The operation was successfully performed in all cases,with no conversion to open surgery.Compared with standard laparoscopic group,the LESS group had significantly lower postoperative pain score（4.3±1.0vs 3.7±0.8,P=0.015）,quicker bowel function recovery（[58.1±16.1]h vs[49.2±14.0]h,P=0.032）,shorter drainage duration（[3.9±1.5]d vs[2.8±1.1]d,P=0.003）,shorter postoperative hospital stay（[7.3±3.1]d vs[6.3±3.4]d,P=0.048）,and a better cosmetic satisfaction score（7.4±0.9vs8.0±0.6,P=0.001）.The operative time and intraoperation blood loss were not significantly different between the two groups.Conclusion Compared to standard laparoscopic nephrectomy,transumbilical LESS nephrectomy offers a quicker recovery of bowel function,shorter drainage duration,a better postoperative pain control,and a better cosmetic satisfaction for benign nonfunctioning kidney,but its long-term therapeutic effect needs to be further verified.

关 键 词：单孔腹腔镜手术 无功能肾 肾切除术 

分 类 号：R699.2[医药卫生—泌尿科学]