经阴道自然腔道内镜手术肾切除术并发症的临床分析  

Complications of transvaginal natural orifice transluminal endoscopic surgery （NOTES） nephrectomy

作　　者：张国玺[1] 刘全亮[1] 邹晓峰[1] 袁源湖[1] 肖日海[1] 薛义军[1] 刘佛林[1] 钟辛[1] 邹毓华[1] 谢昆林 夏维[1] 肖观称 郭桂军[1] 张兆林[1] 

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

出　　处：《中华泌尿外科杂志》2016年第9期647-651,共5页Chinese Journal of Urology

基　　金：国家高技术研发计划（863计划）项目（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（20121BBG70032、20132BAB205007）;江西省科技厅科技支撑计划项目（20151BBG70070）;江西省教育厅科技落地计划项目（KJLD12044）;江西省卫生厅科技计划项目（20111074、20121095）;江西省高校“十二五”重点学科建设经费资助项目

摘　　要：目的：总结经阴道自然腔道内镜手术（ natural orifice transluminal endoscopic surgery， NOTES）肾切除术的并发症发生情况，探讨其防治措施。方法回顾性分析2010年5月至2015年1月施行的178例经阴道NOTES肾切除术患者的临床资料。均为已婚已育女性。年龄23～71岁，平均47岁。体重指数14．7～31．9 kg／m2，平均23．6 kg／m^2。术前诊断为无功能肾142例，肾肿瘤29例（ T1 N0～1 M025例、T2 N0～1 M04例），肾结核7例。行经阴道混合NOTES肾切除术160例，其中单纯性肾切除术132例、根治性肾切除术28例；经阴道纯NOTES肾切除术18例，其中单纯性肾切除术17例、根治性肾切除术1例。分别采用Satava和Clavien-Dindo分级系统评估术中和术后并发症，严重并发症定义为Satava分级≥Ⅱ级或Clavien-Dindo 分级≥Ⅲ级的并发症。分析并发症尤其是严重并发症的发生情况及处理方法。结果本组术中、术后共发生并发症40例（22.5％），其中严重并发症13例（7.3％），包括术中11例（6.2％）、术后2例（1.1％）。所有并发症均采用器官修补或切除、血栓取出、止血等措施得到妥善处置，转归良好。无术中及术后死亡病例。经阴道混合与纯NOTES肾切除术的严重并发症发生例数[11例（6.9％） vs.2例（11.1％）]比较差异无统计学意义（P ＝0.62）。手术开展初期（≤30例）与后期（＞30例）相比，术中严重并发症发生例数[6例（20.0％） vs.5例（3.4％）]差异有统计学意义（P ＝0.004），术后并发症发生例数[4例（13.3％） vs.16例（10.8％）]差异无统计学意义（P＝0.751）。结论经阴道NOTES肾切除术安全可行，但存在发生严重并发症的可能，应采取个体化方案进行防治。Objective To analyze the complications of transvaginal natural orifice transluminal endoscopic surgery（ TV-NOTES） nephrectomy, and to explore effective measures to prevent and manage those complication.Methods From May 2010 to January 2015, a total of 178 females who had been married and given birth underwent TV-NOTES nephrectomy in our center.The average age was 47 （ ranging 23 to 71 ） years and the average BMI was 23.6 （ ranging 14.7 to 31.9 ） kg/m^2.Pathological diagnosis included 142 cases of non-functional kidneys, 29 cases of renal tumors （ T1 N0-1 M0 25 cases, T2 N0-1 M0 4 cases） , and 7 cases of renal tuberculosis.One hundred and sixty hybrid TV-NOTES nephrectomy procedures （simple in 132, radical in 28） and 18 pure TV-NOTES nephrectomy procedures （simple in 17, radical in 1） were performed.Intraoperative and postoperative complications were graded according to Satava and Clavien-Dindo grade classifications.The major complications and relative treatments were analyzed.Results Among the 178 TV-NOTES nephrectomy procedures, there were 40 （ 22.5%） complications occurred, including 13 （7.3%） major complications, in which there were 11 cases of intraoperative complications （6.2%）,2 cases of postoperative complications （1.1%）.All the complications were successfully managed using organ repair or resection, embolectomy, hemostasis, and so on.No intraoperative and postoperative deaths occurred.There was no significant difference in major complications between hybrid TV-NOTES and pure TV-NOTES nephrectomy （6.9%vs.11.1%, P=0.620）.The intraoperative major complications in the early developmental stage of TV-NOTES nephrectomy were more than that of the late stage （20.0%vs.3.4%, P=0.004）.There was no significant difference in postoperative complications between the early and late developmental stage of TV-NOTES nephrectomy （13.3%vs.10.8%, P=0.751）.Conclusions TV-NOTES nephrectomy is safe and feasible, but there are some major complications worthy of attention.Personal

关 键 词：经自然腔道内镜手术 经阴道途径 肾切除术 并发症 

分 类 号：R699.2[医药卫生—泌尿科学]