泌尿外科耻骨上辅助经脐单孔腹腔镜手术并发症的临床分析  

Complications of suprapubic-assisted laparoendoscopic single-site surgery in urology

作　　者：徐刚[1] 黎衍敏[1] 邹晓峰[1] 张国玺[1] 袁源湖[1] 肖日海[1] 伍耿青[1] 王晓宁[1] 刘佛林[1] 谢天朋[1] 陈汉民[1] 谢昆林 肖观称 夏维[1] 张兆林[1] 郭桂军[1] XU Gang LI Yanmin ZOU Xiaofeng ZHANG Guoxi YUAN Yuanhu XIAO Rihai WU Gengqing WANG Xiaoning LIU Fulin XIE Tianpeng CHEN Hanmin XIE Kunlin XIAO Guancheng XIA Wei ZHANG Zhaolin GUO Guijun(Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, 341000, China)

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,江西赣州341000

出　　处：《临床泌尿外科杂志》2017年第3期174-177,共4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);江西省高校"十二五"重点学科建设经费资助项目

摘　　要：目的:分析泌尿外科耻骨上辅助经脐单孔腹腔镜手术(SA-LESS)并发症,探讨其防治措施。方法:回顾性分析2010年7月~2015年4月施行的573例SA-LESS手术病例资料,其中男356例,女217例,平均年龄45.4(6~78)岁,平均身体质量指数23.6(15.3~32.8)kg/m^2。包括单纯性肾切除术150例、根治性肾切除术64例、肾部分切除术16例、重复肾切除术15例、上尿路全切除术29例、肾上腺或肾上腺肿瘤切除术43例、肾囊肿去顶术34例、肾盂或输尿管切开取石术183例、肾盂成形术15例、输尿管膀胱再植术24例。分别采用Satava和Clavien-Dindo分级系统评估术中和术后并发症,并重点分析严重并发症及其处理。结果:本组术中、术后共发生并发症65例(11.34%),其中严重并发症21例(3.66%)。术中严重并发症12例,包括下腔静脉损伤3例、肾静脉损伤3例、髂静脉损伤1例、胸膜损伤1例、十二指肠损伤1例、回肠损伤1例、脾脏损伤1例、股神经损伤1例;术后严重并发症9例,包括继发性出血5例、术后尿漏3例、肾盂成形术后再次狭窄1例。所有并发症均得到妥善处置,转归良好。无术中及术后死亡病例。结论:SA-LESS安全可行,但存在一定的严重并发症,应采取相应措施积极防治。Objective：To analyze the complications of urologic suprapubic-assisted laparoendoscopic single-site surgery（SA-LESS）,and to explore effective measures for its prevention and management.Method：From July2010 to April 2015,a total of 573 cases underwent SA-LESS in our center.Of them 356 were men and 217 were women.The median age was 45.4（range,6-78）years old,and the median body mass index was 23.6（range,15.3-32.8）kg/m^2.The various SA-LESS procedures included nephrectomy（n=214;simple 150,radical 64）,partial nephrectomy（n=16）,heminephroureterectomy for duplex kidney（n=15）,nephroureterectomy（n=29）,adrenalectomy（n=43）,renal cyst excision（n=34）,pyelolithotomy or ureterolithotomy（n=183）,pyeloplasty（n=15）and ureterovesical reimplantation（n=24）.Intraoperative and postoperative complications were graded according to Satava and Clavien-Dindo grade classifications,respectively.The severe complications and their treatments were mainly analyzed.Result：Among the 573SA-LESS procedures,there were 65（11.34%）complications occurred,including 21（3.66%）severe complications.The intraoperative severe complications included inferior vena cava injury（n=3）,renal vascular injury（n=3）,iliac vein injury（n=1）,pleural injury（n=1）,duodenal injury（n=1）,ileum injury（n=1）,spleen injury（n=1）and femoral nerve injury（n=1）.The postoperative severe complications included secondary hemorrhage（n=5）,urinary leakage（n=3）and ureteropelvic junction stenosis after pyeloplasty（n=1）.No intraoperative or postoperative death occurred.Conclusion：SA-LESS is safe and feasible in urology,but there are some severe complications for consideration.

关 键 词：单孔腹腔镜术 经脐途径 耻骨联合 并发症 

分 类 号：R572[医药卫生—消化系统]