机器人辅助腹腔镜肾部分切除术围手术期患者管理研究  

Comparative study of perioperative management between different robot-assisted laparoscopic partial ne-phrectomies

作　　者：张丽峰[1] 刘国俊[1] 马鑫[1] 赵楠 郭刚[1] ZHANG Lifeng;LIU Guojun;MA Xin;ZHAO Nan;GUO Gang(Department of Urology,Third Center of the General Hospital of PLA,Beijing 100069,China)

机构地区：[1]解放军总医院第三医学中心泌尿外科医学部,北京100069

出　　处：《现代泌尿生殖肿瘤杂志》2022年第3期139-143,共5页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的分析达芬奇Xi机器人辅助腹腔镜经腹腔肾部分切除术与经后腹腔肾部分切除术治疗肾肿瘤围手术期患者的管理特点,从而制定不同患者的管理策略。方法回顾性分析2022年1月至2022年4月在解放军总医院第三医学中心泌尿外科医学部行达芬奇Xi机器人辅助腹腔镜肾部分切除术的患者57例,其中经腹腔入路组34例,经后腹腔入路组23例。比较两组患者术前准备、手术时间、热缺血时间、术中血红蛋白下降值、围手术期输血率、术后24 h出血量、术后引流液量、术后24 h疼痛评分、术后住院时间、术后排气及下地活动时间、留置引流管时间、手术切口护理情况、并发症发生率及术后患者满意率等,并制定不同的管理策略。结果两组患者手术均顺利完成,经后腹腔镜入路组和经腹腔入路组的手术时间分别为[(78.0±28.7)min vs(95.0±30.5)min,P=0.023],热缺血时间[(15.0±10.8)min vs(20.0±12.5)min,P=0.003],术中血红蛋白下降值[(10.0±1.5)g/L vs(15.0±2.1)g/L,P=0.005],术后引流量[(155.0±28.5)ml vs(262.0±50.4)ml,P=0.001],术后排气时间[(28.0±5.8)h vs(48.0±6.5)h,P=0.004],术后并发症发生率[17.4%vs 23.5%,P=0.034],术后留置引流管时间[(72.0±8.7)h vs(98.0±10.2)h,P=0.005],术后住院时间[(5.0±1.5)d vs(6.0±1.8)d,P=0.002],两组间比较差异有统计学意义。与经后腹腔镜入路组相比,经腹腔入路组围手术期护理流程更多,尤其在术前肠道准备及术后康复过程方面。结论机器人辅助腹腔镜经腹腔和经后腹腔肾部分切除术均是安全有效治疗肾肿瘤的微创术式,应根据肿瘤位置及大小选择不同的手术路径,根据手术方式选择不同的围手术期护理策略将有效提高患者的整体护理质量。Objective To analyze the perioperative management of Da Vinci Xi robot-assisted transperitoneal or retroperitoneal laparoscopic partial nephrectomy for renal tumor,and develop different nursing strategies.Methods From Jan.2022 to Apr.2022,57 patients with early stage renal tumor treated with Da Vinci Xi robot-assisted laparoscopic partial nephrectomy were retrospectively analysed.Thirty-four patients received transperitoneal approach operation and twenty-three patients received retroperitoneal approach operation.Preoperative preparation,operation time,warm ischemia time,intraoperative drop in hemoglobin,perioperative blood transfusion rate,24 h postoperative bleeding,postoperative volume of drainage fluid,24 h postoperative pain score,postoperative discharge time,postoperative,drainage time,surgical incision care,complication rate,etc.were compared between the two groups.Results The operations were completed successfully in both groups.The operation time in the retroperitoneal approach and transperitoneal approach groups was[(78.0±28.7)min vs(95.0±30.5)min,P=0.023],and the warm ischemia time was[(15.0±10.8)min vs(20.0±12.5)min,P=0.003].The intraoperative decrease in hemoglobin value was[(10.0±1.5)g/L vs(15.0±2.1)g/L,P=0.005],and the postoperative volume of drainage fluid was[(155.0±28.5)ml vs(262.0±50.4)ml,P=0.001].The postoperative exhaust time was[(28.0±5.8)h vs(48.0±6.5)h,P=0.004],and postoperative complication rate was(17.4%vs 23.5%,P=0.034).The postoperative indwelling drainage time was[(72.0±8.7)h vs(98.0±10.2)h,P=0.005],and the postoperative length of hospital stay was[(5.0±1.5)d vs(6.0±1.8)d,P=0.002].The differences were statistically significant.Compared with the retroperitoneal approach group,the peritoneal approach group had more perioperative nursing procedures,especially in intestinal preparation,prevention of complications and postoperative rehabilitation.Conclusions Robot-assisted transper-itoneal and retroperitoneal laparoscopic partial nephrectomy are both safe and effective minimal

关 键 词：机器人辅助 腹腔镜 后腹腔镜 肾部分切除术 护理 

分 类 号：R473.73[医药卫生—护理学]