本文選題：腎盂輸尿管連接處梗阻 + 機(jī)器人輔助腹腔鏡腎盂成形術(shù)�。� 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]探討和比較分析三種腎盂成形手術(shù)方式(機(jī)器人輔助腹腔鏡、傳統(tǒng)腹腔鏡和開放)對(duì)于治療腎盂輸尿管連接處梗阻(ureteropelvic junction obstruction,UPJO)的臨床療效。[方法]回顧性分析了2013年10月~2016年3月我院收治的腎盂輸尿管連接處梗阻患者71例,以三種不同方式行腎盂成形術(shù)治療,分別為機(jī)器人輔助腹腔鏡(ro botic-assisted laparoscopic pyeloplasty,RALP)組16例,傳統(tǒng)腹腔鏡(laparoscop ic pyeloplasty,LP)組20例,開放式(open pyeloplasty,OP)組35例。觀察比較三種方式的手術(shù)時(shí)間、術(shù)中出血量、腎周引流量及腎周引流管拔出天數(shù)、住院費(fèi)用、住院天數(shù)、手術(shù)并發(fā)癥情況以及術(shù)后腎積水復(fù)發(fā)等指標(biāo)。全部統(tǒng)計(jì)分析采用SPSS 16.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)分析,P0.05為差異有統(tǒng)計(jì)學(xué)意義。[結(jié)果]所有患者手術(shù)均成功完成,RALP及LP組無1例轉(zhuǎn)為開放手術(shù)。RALP組平均手術(shù)時(shí)間為(72.69±16.78)min,平均出血量為(21.25±8.85)ml,平均腎周引流量為(30.94±12.94)ml,平均拔管天數(shù)為(2.63±0.72)天,平均住院天數(shù)為(4.19±0.91)天,平均住院費(fèi)用為(46055.0±5181.1)元,RALP組術(shù)后出現(xiàn)1例泌尿系感染,1例肺部感染;LP組平均手術(shù)時(shí)間為(125.60±35.36)min,平均出血量為(52.50±27.60)ml,平均腎周引流量為(53.25±21.42)ml,平均拔管天數(shù)為(3.95±1.54)天,平均住院時(shí)間為(5.90±0.85)天,平均住院費(fèi)用為(25134.0±7740.3)元,LP組出現(xiàn)3例泌尿系感染,1例漏尿;OP組平均手術(shù)時(shí)間為(127.40±42.64)min,平均出血量為(67.71±28.50)ml,平均腎周引流量為(74.86±37.43)ml,平均住院天數(shù)為(6.94±0.91)天,平均住院費(fèi)用為(20384.0±6259.5)元,OP組術(shù)后出現(xiàn)3例泌尿系感染,2例漏尿,1例出血。三組術(shù)式的性別、年齡、體重指數(shù)、美國麻醉醫(yī)生協(xié)會(huì)評(píng)分分級(jí)、發(fā)病位置對(duì)比差異無統(tǒng)計(jì)學(xué)意義(P0.05)。手術(shù)時(shí)間RALP組明顯短于LP組和OP組,差異有統(tǒng)計(jì)學(xué)意義(P0.001);LP組和OP組差異無統(tǒng)計(jì)學(xué)意義。術(shù)中出血量、術(shù)后腎周引流量及拔管天數(shù)、術(shù)后住院天數(shù)、住院費(fèi)用3組患者差異有統(tǒng)計(jì)學(xué)意義(P0.05)。LP組較OP組微創(chuàng),術(shù)中出血量、術(shù)后腎周引流量及腎周引流管拔出天數(shù)、住院天數(shù)均減少,RALP組則將這些優(yōu)勢(shì)進(jìn)一步擴(kuò)大,但費(fèi)用明顯高于其他組。手術(shù)并發(fā)癥3組患者無明顯差異,均無嚴(yán)重并發(fā)癥發(fā)生(P0.05)。3組患者術(shù)后隨訪2-31個(gè)月,通過定期行彩超、靜脈腎盂造影(IVU)、泌尿系磁共振水成像(MRU)、腎圖、核素動(dòng)態(tài)腎臟顯像(選擇其中1至3項(xiàng))檢查,證實(shí)均未再發(fā)梗阻,腎盂積水均有不同程度減輕,分腎功能均有不同程度改善。[結(jié)論]與開放式的手術(shù)相比,腹腔鏡的手術(shù)在安全性和可行性上并無顯著的差異,但是腹腔鏡的手術(shù)的優(yōu)點(diǎn)在于術(shù)中出血少、創(chuàng)傷小和術(shù)后痛苦少、恢復(fù)快,將會(huì)是治療腎盂輸尿管連接部梗阻手術(shù)的發(fā)展趨勢(shì)。而機(jī)器人輔助腹腔鏡手術(shù)系統(tǒng)具有三維、放大的手術(shù)視野,從而可以讓腹腔鏡下復(fù)雜手術(shù)的難度降低,同時(shí)也可以減少手術(shù)當(dāng)中對(duì)組織的副損傷,尤其對(duì)于組織和器官功能的重建手術(shù)更加適合。RALP組方式將逐漸替代LP組和OP組手術(shù)方式,可以讓有條件的醫(yī)院有了治療UPJO的新選擇。
[Abstract]:[Objective] to explore and compare the clinical effects of three types of pyeloplasty (robot assisted laparoscopy, traditional laparoscopy and opening) for the treatment of ureteropelvic junction obstruction (UPJO). [Methods] a retrospective analysis was made of the renal pelvis ureteral junction in our hospital in March, ~2016, October 2013. 71 cases of obstructive patients were treated with three different ways of renal pyeloplasty, 16 cases of RO botic-assisted laparoscopic pyeloplasty, RALP group, 20 cases of traditional laparoscopy (laparoscop IC pyeloplasty, LP), 35 cases of open (open pyeloplasty, OP) group. The operation time of three methods was compared and the operation time was observed and compared. Blood volume, peri renal flow rate and the number of days, hospitalization costs, days of hospitalization, complications of operation and recurrence of hydronephrosis after operation. All statistical analysis was made by statistical analysis of SPSS 16 statistical software. P0.05 was statistically significant. [results] the patients were successfully completed, and no 1 cases in group RALP and LP were transferred. The average operation time of the.RALP group was (72.69 + 16.78) min, the average bleeding amount was (21.25 + 8.85) ml, the average renal peritenal flow rate was (30.94 + 12.94) ml, the average extubation day was (2.63 + 0.72) days, the average hospitalization days were (4.19 + 0.91) days, the average hospitalization cost was (46055 + 5181.1) yuan. After RALP group, there were 1 cases of urinary tract infection and 21.25 lungs. The average operation time of the LP group was (125.60 + 35.36) min, the average bleeding volume was (52.50 + 27.60) ml, the average perirenal flow rate was (53.25 + 21.42) ml, the average extubation day was (3.95 + 1.54) days, the average hospitalization time was (5.90 + 0.85) days, the average hospitalization cost was (25134 + 7740.3) yuan, and the LP group had 3 cases of urinary tract infection and leakage of urine; OP group was flat. The average operation time was (127.40 + 42.64) min, the average bleeding amount was (67.71 + 28.50) ml, the average renal peritenal flow rate was (74.86 + 37.43) ml, the average hospitalization days were (6.94 + 0.91) days, the average hospitalization cost was (20384 + 6259.5) yuan (20384 + 6259.5), 3 urinary tract infection after operation, 2 cases of leakage of urine, 1 bleeding. There was no significant difference in the contrast of the incidence of the anesthesiologist Association (P0.05). The operation time RALP group was significantly shorter than the LP group and the OP group, and the difference was statistically significant (P0.001). There was no significant difference between the group LP and the OP group. The amount of intraoperative bleeding, the postoperative flow rate of the kidney and the number of extubation days, the days after the operation and the cost of the 3 groups of hospitalization expenses were different. Statistically significant (P0.05) group.LP was less invasive than group OP, intraoperative bleeding, postoperative flow rate of renal perirenin and the number of days of renal peripheral drainage tube pulling out, the number of days in hospital decreased, and the RALP group further expanded these advantages, but the cost was significantly higher than that of the other groups. The 3 groups of patients with complications of operation showed no serious complications (P0.05).3 group operation. After 2-31 months follow-up, through regular color Doppler ultrasound, intravenous pyelography (IVU), urography magnetic resonance hydrography (MRU), nephrography, and nuclide dynamic renal imaging (selection of 1 to 3 items), there was no further obstruction. The hydronephrosis was alleviated in varying degrees and the renal function was improved in varying degrees. [Conclusion] compared with open surgery, abdomen Endoscopic surgery has no significant differences in safety and feasibility, but the advantages of laparoscopic surgery are less bleeding, less trauma, less postoperative pain, and rapid recovery, which will be a trend in the treatment of ureteropelvic junction obstruction, and the robot assisted laparoscopic surgery system has a three-dimensional and magnified visual field. It can reduce the difficulty of complicated laparoscopic surgery and reduce the secondary injury to the tissue in the operation, especially for the reconstruction of tissue and organ function, which is more suitable for the.RALP group to replace the LP group and the OP group, which can allow the conditional hospital to have a new choice for the treatment of UPJO.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R699

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