经阴道3D腹腔镜肾切除术的初步应用效果  

PRELIMINARY APPLICATION OF TRANSVAGINAL THREE-DIMENSIONAL LAPAROSCOPIC NEPHRECTOMY

作　　者：徐辉[1] 伍耿青[1] 徐瑞权[1] 邹晓峰[1] 张国玺[1] 袁源湖[1] XU Hui;WU Gengqing;XU Ruiquan;ZOU Xiaofeng;ZHANG Guoxi;YUAN Yuanhu(Institute of Urology,Gannan Medical University,Ganzhou 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)

出　　处：《青岛大学学报（医学版）》2019年第5期536-539,共4页Journal of Qingdao University(Medical Sciences)

基　　金：国家高技术研发计划(863计划)项目(2012AA-021100);江西省“赣鄱英才555工程”领军人才培养计划项目;赣州市科技局科技计划项目(GZ2014ZSF058)

摘　　要：目的 探讨3D腹腔镜下经阴道自然腔道内镜(TV-NOTES)肾切除术的初步效果。方法 回顾性分析2013年10—11月、2014年6—7月,由同一组术者施行的TV-NOTES肾切除术共24例临床资料。3D腹腔镜下TV-NOTES肾切除术8例(A组),2D腹腔镜下TV-NOTES肾切除术16例(B组)。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(VAPS)、术后住院天数、并发症发生率及病人瘢痕评估问卷评分(PSAQ)等,分析两种手术方式的技术特点。结果 24例手术均获成功,两组病人术中、术后均未出现严重并发症。术后第1~2天下床活动,第2~3天肛门排气并进饮食。两组手术时间、术中出血、引流管拔除时间、术后VAS评分、术后住院时间、术后PSAQ评分等比较,差异均无统计学意义(P>0.05)。术后随访时间内所有病例无腹腔、盆腔感染及切口疝形成。结论 3D腹腔镜下TV-NOTES肾切除术与2D腹腔镜下手术疗效相当;但3D腹腔镜下手术视野更为清晰,解剖层次清楚,空间感强,定位更精确,手术难度降低。Objective To investigate the preliminary effect of three-dimensional (3D) laparoscopic transvaginal natural orifice transluminal endoscopic surgery (TV-NOTES) nephrectomy. Methods A retrospective analysis was performed for the clinical data of 24 patients who underwent 3D laparoscopic TV-NOTES nephrectomy performed by the same surgical group from October to November, 2013 and from June to July, 2014. Eight patients undergoing 3D laparoscopic TV-NOTES nephrectomy and 16 patients undergoing 2D laparoscopic TV-NOTES nephrectomy were allocated into group A and group B, respectively. The two groups were compared in terms of operation time, volume of intraoperative blood loss, time to removal of abdominal drainage tube, postoperative visual analogue pain score (VAPS), length of postoperative hospital stay, incidence of complications, and patient scar assessment questionnaire (PSAQ) score, and technical characteristics of the two surgical methods were analyzed. Results All the 24 patients underwent successful surgeries, and no serious complication occurred intraoperatively or postoperatively in the two groups. The patients got out of bed at 1-2 d after surgery, and had passage of gas by anus and resumed to diet at 2-3 d after surgery. There were no significant differences in operation time, volume of intraoperative blood loss, time to removal of abdominal drainage tube, postoperative VAPS, length of postoperative hospital stay, and postoperative PSAQ score between the two groups ( P >0.05). There was no abdominal infection, pelvic infection, or incisional hernia in all patients during the follow-up. Conclusion 3D laparoscopic TV-NOTES nephrectomy has similar efficacy to 2D laparoscopic TV-NOTES nephrectomy;however,3D laparoscopic surgery can provide a clearer field of vision and a more accurate location, with clear anatomical layers and a strong sense of space, and reduce the operation difficulty.

关 键 词：肾切除术 腹腔镜检查 成像 三维 阴道 治疗结果 

分 类 号：R699.2[医药卫生—泌尿科学] R445[医药卫生—外科学]