经脐入路辅助耻骨上或经阴道穿刺通道腹腔镜粘连肾切除技术的探讨  

Comparative study between suprapubic-assisted transumbilical and transvaginal approach for laparoscopic nephrectomy for infective nonfunctioning kidney with perinephric adhesion

作　　者：廖云峰[1,2] 徐辉[1,2] 邹晓峰[1,2] 张国玺[1,2] 肖日海[1,2] 袁源湖[1,2] 伍耿青[1,2] 王晓宁[1,2] 刘佛林[1,2] 薛义军[1,2] 龙大治 吴玉婷[1,2] 江波[1,2] 杨增祥[1,2] 刘林伟 

机构地区：[1]赣南医学院第一附属医院泌尿外科 [2]赣南医学院泌尿外科研究所,江西赣州341000

出　　处：《临床泌尿外科杂志》2015年第5期385-388,392,共5页Journal of Clinical Urology

基　　金：国家高技术研发计划(863计划)项目(编号2012AA021100);江西省"赣鄱英才555工程"领军人才培养计划项目;江西省科技厅重大科技支撑计划项目(编号20121BBG70032;20132BAB205007);江西省卫生厅重大科技计划项目(编号20104008);江西省教育厅科技落地计划项目(编号KJLD12044)

摘　　要：目的：探讨经脐人路辅助耻骨上或经阴道穿刺通道腹腔镜粘连肾切除技术的要点及临床价值。方法：2010年5月～2014年6月采用肾周筋膜内肾切除技术48例（A组），其中行经阴道混合NOTES（TV—NOTES）23例（A，组），耻骨上辅助单孔腹腔镜手术（SA-LESS）25例（A2组），男21例，女27例，平均年龄37．5岁；包括肾结核4例，非特异性感染脓肾44例，其中既往有肾脏手术史11例。采用肾周筋膜外整块肾切除技术45例（B组），其中行TV-NOTES21例（B1组），SA—LESS24例（B2组），男17例，女28例，平均年龄39．2岁；包括肾结核5例，非特异性感染脓肾40例，其中既往有肾脏手术史9例。比较两组的手术时间、术中出血量、术后拔除腹腔引流管时间、术后视觉模拟疼痛评分、术后住院天数、中转开放手术率以及术后并发症发生率等。结果：88例手术成功完成，A组5例中转开放手术。A1组与B1组、A2组与B2组手术时间、术中出血量、术后拔除腹腔引流管时间、中转开放手术率以及术后并发症发生率比较，差异均有统计学意义（P〈0．05），术后视觉模拟疼痛评分、术后住院天数等指标比较，差异均无统计学意义（P〉0．05）。结论：经脐入路新型腹腔镜肾周筋膜外粘连肾整块切除技术安全、可行，术程简洁，降低了手术难度，具有出血少、并发症少、美容效果佳等优势，有临床应用价值。Abstract Objective：To compare the clinical values between suprapubic-assisted transumbilical and transvagi- nal approach for laparoscopic nephrectomy for infective nonfunctioning kidney with perinephric adhesion. Method： From May 2010 to June 2014, a retrospective analysis of 93 patients who underwent a novel laparoscopic nephrec- tomy via transumbilical approach was performed. A total of 48 patients （Group A）, including 21 males and 27 fe- males, underwent perirenal intrafascia nephrectomy. The mean age of these patients was 37.5 years old. Therewere 44 patients with pyonephrosis for nonspecific infection, and four with nephrotuberculosis. There were 11 pa- tients with the history of previous ipsilateral renal surgery in Group A. In group A, 23 patients underwent trans- vaginal natural orifice transluminal endoscopic surgery （TV-NOTES） （Group A1 ）, and the other 25 patients un- derwent suprapubic-assisted laparoendoscopic single-site surgery （SA-LESS） （Group A2 ）. Another 45 patients （Group B）, including 17 males and 28 females, underwent perirenal extrafascia nephrectomy. The mean age of these patients was 39.2 years old. There were 40 patients with pyonephrosis for nonspecific infection, and five with nephrotuberculosis. There were nine patients with history of previous ipsilateral renal surgery in Group B. In this group, 21 patients underwent TV-NOTES （Oroup B1）, and the other 24 underwent SA-LESS （Group Bz）. The parameters including operative time, estimated blood loss, indwelling drain time, postoperative visual ana- logue scale, postoperative hospital stay and intraoperative or postoperative complications were recorded. Resttlt Totally 88 patients were successfully completed. Five patients in group A experienced conversion to open surgery. The operative time, estimated blood loss, indwelling drain time, intraoperative and postoperative complications showed statistically significant differences between group Al and B1, and between group Az and Bz, respectively （P〈0.

关 键 词：经脐入路 粘连肾 肾切除术 

分 类 号：R692[医药卫生—泌尿科学]