组织粉碎器在腹膜后腹腔镜肾癌根治术中的应用研究  

Application study of endoscopic tissue morcellator in retroperitoneoscopic radical nephrectomy

作　　者：汤乘 阳光 徐勇 瞿根义 向茂林 王佳威 TANG Cheng;YANG Guang;XU Yong(Department of Urology,the Affiliated Zhuzhou Hospital Xiang Ya Medical College Central South University,Zhuzhou 412007,China)

机构地区：[1]中南大学湘雅医学院附属株洲医院泌尿外科,湖南株洲412007

出　　处：《腹腔镜外科杂志》2021年第10期784-788,796,共6页Journal of Laparoscopic Surgery

基　　金：株洲市科技计划项目(2019-001)。

摘　　要：目的:评估组织粉碎器在腹膜后腹腔镜肾癌根治术中清除腹膜后脂肪的安全性及临床疗效。方法:根据纳入标准前瞻性纳入2018年6月至2020年12月行腹膜后腹腔镜肾癌根治术的208例肾癌患者,先将患者分为肥胖组(BMI≥28 kg/m^(2))与非肥胖组(BMI<28 kg/m^(2)),再随机分入实验组(应用组织粉碎器)与对照组(行传统腹膜后腹腔镜肾癌根治术)。肥胖组纳入50例患者,其中实验组26例,对照组24例;非肥胖组纳入158例患者,实验组78例,对照组80例。比较两个亚组手术相关指标。结果:两亚组患者年龄、BMI、ASA分级、肿瘤位置、肿瘤大小、术前血肌酐等临床资料差异无统计学意义(P>0.05),在肥胖组与非肥胖组中,实验组手术时间、术中出血量、腹膜后引流管总引流量均优于对照组,差异有统计学意义(P<0.05),两亚组并发症发生率、总住院时间、总生存率及无疾病进展生存率差异无统计学意义(P>0.05)。结论:在肥胖或非肥胖患者中,尤其肥胖患者,应用组织粉碎器改进腹膜后腹腔镜肾癌根治术具有手术时间更短、出血量更少的优点,组织粉碎器利于术者操作,具有更显著的优势,值得推广应用。Objective:To evaluate the safety and clinical efficacy of endoscopic tissue morcellator for clearance of retroperitoneal adipose in retroperitoneoscopic radical nephrectomy.Methods:From Jun.2018 to Dec.2020,208 patients who received retroperitoneoscopic radical nephrectomy were included according to the inclusion criteria prospectively.The patients were first divided into obese group(BMI≥28 kg/m^(2))and non-obese group(BMI<28 kg/m^(2)),then they were randomly divided into the experimental group(using endoscopic tissue morcellator to remove retroperitoneal adipose)and the control group(traditional retroperitoneoscopic radical nephrectomy).Among 50 patients in the obese group,26 patients were in the experimental group,24 patients were divided into the control group.Among 158 patients of non-obese group,78 patients were divided into the experimental group,and 80 patients were in the control group.Finally,the related perioperative characteristics and clinical efficacy of the two subgroups were compared and analyzed.Results:There was no statistically significant difference in the baseline data of the two subgroups in age,BMI,ASA grade,tumor location,tumor size,and preoperative serum creatinine(P>0.05).Regardless of the obese group or the non-obese group,the operation time of the experimental group was shorter,the intraoperative blood loss was less,the total drainage volume was less than that of the control group,and the difference was statistically significant(P<0.05),there was no significant difference in the incidence of complications,the total hospital stay,overall survival rate and tumor-free survival rate(P>0.05).Conclusions:For obese or non-obese patients,especially for obese patients,compared with traditional retroperitoneoscopic radical nephrectomy,the improved retroperitoneoscopic radical nephrectomy with endoscopic tissue morcellator has the advantages of shorter operation time,less bleeding,and less retroperitoneal drainage.It is conducive to the operation of the surgeon,has more significant advantages,an

关 键 词：肾肿瘤 肾癌根治术 腹腔镜检查 腹膜后路径 组织粉碎器 

分 类 号：R737.11[医药卫生—肿瘤]