改良吻合技术对后腹腔镜肾盂成形术学习曲线的改进  

Modified anastomosis for the improvement of learning curve in retroperitoneal laparoscopic dismembered pyeloplasty

作　　者：温元毅 王勇[1] 马鑫 胡成[2] Wen Yuanyi;Wang Yong;Ma Xin;Hu Cheng(Department of Urology,the First People＇s Hospital,of Ziyang,Sichuan 641300,China;Department of Urology,the Third Affliated Hospital of SunYat-sen University,Guangzhou 510630,China)

机构地区：[1]资阳市第一人民医院泌尿外科,四川641300 [2]中山大学附属第三医院泌尿外科,广州510630

出　　处：《中华腔镜泌尿外科杂志（电子版）》2018年第4期244-247,共4页Chinese Journal of Endourology(Electronic Edition)

基　　金：广东省医学科学技术研究基金项目(A2016435);广东省自然科学基金项目(2017A030313620)

摘　　要：目的评价后腹腔镜肾盂成形术中改良吻合技术对术者学习曲线的改进。方法回顾性分析自2015年4月至2017年6月在资阳市第一人民医院接受腹腔镜肾盂输尿管离断成形术的患者资料,共33例,平均年龄17岁(4~41岁),根据术中是否采用腹腔镜带线悬吊技术,将患者分为传统腹腔镜组与改良组。分别比较两组患者的术前、手术及术后恢复情况。结果所有手术均在腔镜下完成,无一例中转开放。患者术前资料差异无统计学意义(P>0.05)。改良组总手术时间,特别是肾盂输尿管吻合时间,以及术后第1天疼痛评分显著优于传统腹腔镜组(P<0.05)。两组患者在术中预计出血量、术后住院时间、术后并发症发生率方面差异无统计学意义(P>0.05)。结论带线悬吊的改良吻合技术可显著减少初学者施行肾盂输尿管离断成形术的手术时间及手术难度,缩短学习曲线时间,值得临床推广。Objective To evaluate the perioperative outcomes and explore the improvement of learning curve of modified anastomosis for retroperitoneal laparoscopic dismembered pyeloplasty. Methods A total of 33 cases of uretero-pelvic junction obstruction（UPJO） with mean age of 17（4-41） years were recruited for pyeloplasty since April 2015 to June 2017. Two groups were classified, conventional and modified group, according to the operation applications whether with the help of suspension technique introduced from the First People＇s Hospital of Ziyang. Perioperative data, complications and follow-up data were collected and analyzed retrospectively. Results All surgeries were successfully performed laparoscopically, no conversion to open surgery. Operative time, especially anastomosis time and visual pain score（VPS） on the first postoperative day was significantly shorter in modified group compared with conventional laparoscopic group（P〈0.05）, there was no difference of estimated blood loss, postoperative hospital stay and mortality rate between the two groups（P〈0.05）. Conclusion Modified suspension anastomosis technique for laparoscopic pyeloplasty is safe and effective, the approach can reduce operative time, shorter learn curves and it＇s especially suitable for beginners to grasp the sophisticated surgery.

关 键 词：腹腔镜 肾盂输尿管成形术 肾盂输尿管连接部梗阻 学习曲线 悬吊 

分 类 号：R699[医药卫生—泌尿科学]