腹腔镜腹盆腔肿瘤手术中输尿管损伤后尿路重建:手术时机与再行腹腔镜术的可行性  

Reconstruction of urinary tract after ureteral injury during laparoscopic laparoscopic pelvic tumor surgery:operation timing and feasibility of a second laparoscopic surgery

作　　者：郭孝峰 杨铁军 赵世明 马永康 宋进波 董秉琪 何朝宏 郝建伟[2] GUO Xiao-feng;YANG Tie-jun;ZHAO Shi-ming;MA Yong-kang;SONG Jin-bo;DONG Bing-qi;HE Chao-hong;HAO Jian-wei(Department of Urology,Affiliated Tumor Hospital of Zhengzhou University,Henan Provincial Cancer Hospital,Zhengzhou 450008;Department of Urology,Affiliated People s Hospital of Zhengzhou University,Henan Provincial People's Hospital,Zhengzhou 450008,China)

机构地区：[1]郑州大学附属肿瘤医院,河南省肿瘤医院泌尿外科,河南郑州450008 [2]郑州大学附属人民医院,河南省人民医院泌尿外科,河南郑州450008

出　　处：《现代泌尿外科杂志》2020年第6期496-500,共5页Journal of Modern Urology

摘　　要：目的评估腹腔镜下腹盆腔肿瘤手术损伤输尿管后尿路重建的时机及再行腹腔镜的可行性。方法回顾性分析河南省肿瘤医院及河南省人民医院2014年10月至2018年6月腹腔镜下腹盆腔手术损伤输尿管后行尿路修复重建的67例患者的临床资料。根据修复手术与前次手术的间隔时间(≤2周和>2周)分为即刻组(41例)和择期组(26例);根据修复手术方式分为腔镜组(34例)和开放组(33例)。分别比较即刻组和择期组、腔镜组和开放组患者尿路重建术后腹腔感染率、术后1周输尿管吻合口瘘发生率、引流管留置时间、住院时间、肾积水发生率(新发肾积水或原有肾积水程度加重)等指标。结果术后随访1年,即刻组与择期组相比:术后腹腔感染发生率、拔出输尿管支架管后肾积水发生率方面差异无统计学意义(P>0.05)。腔镜组与开放组相比:术后1周输尿管瘘发生率、拔出输尿管支架管后肾积水发生率方面差异无统计学意义(P>0.05);在术后腹腔感染发生率[38.2%(13/34)vs.63.6%(21/33)]、腹腔引流管留置时间[(6.87±1.32)d vs.(11.73±0.54)d]、住院时间[(11.94±0.79)d vs.(20.69±2.03)d]方面差异有统计学意义(P<0.05)。结论输尿管损伤后,即刻尿路重建与择期尿路重建可取得相同的效果,而腹腔镜下较开放手术能明显减少术后并发症的发生,同时缩短腹腔引流管留置时间及住院时间,有明显的加速康复优势。Objective To evaluate the timing of urinary tract reconstruction and feasibility of a second laparoscopic surgery after laparoscopic pelvic tumor surgery for ureteral injury.Methods The clinical data of 67 patients undergoing urinary tract reconstruction after laparoscopic abdominal pelvic surgery during Oct.2014 and Jun.2018 in Henan Provincial Cancer Hospital and Henan Provincial People s Hospital were retrospectively analyzed.The patients were divided into immediate surgery group(n=41)and elective surgery group(n=26)according to the interval between repair operation and the previous operation(≤2 weeks and>2 weeks).According to the method of repair surgery,they were divided into laparoscopic group(n=34)and open surgery group(n=33).The intraperitoneal infection rate after urinary tract reconstruction,incidence of ureteral anastomotic leakage,time of drainage tube removal,length of hospital stay,and incidence of hydronephrosis(new hydronephrosis or aggravation of the original hydronephrosis)were compared between the immediate and elective surgery groups,and between the endoscopic and open surgery groups.Results During the 1-year follow-up,there were no significant differences in intraperitoneal infection rate and incidence of hydronephrosis between the immediate operation group and elective surgery group(P>0.05).There were no significant differences in incidence of ureteral anastomotic leakage and incidence of hydronephrosis(P>0.05)between the laparoscopic group and open surgery group 1 week after operation,but the laparoscopic group had lower intraperitoneal infection rate[38.2%(13/34)vs.63.6%(21/33)],shorter time of drainage tube removal[(6.87±1.32)d vs.(11.73±0.54)d],and shorter length of hospital stay[(11.94±0.79)d vs.(20.69±2.03)d]than the open surgery group(P<0.05).Conclusion After ureteral injury,immediate urinary tract reconstruction can achieve the same effect as elective urinary tract reconstruction.Laparoscopic surgery can significantly reduce postoperative complications,and shorten the time of d

关 键 词：腹腔镜 输尿管损伤 即刻手术 再次手术 

分 类 号：R737.1[医药卫生—肿瘤]