發(fā)布時間：2018-06-09 20:30

  本文選題：單孔腹腔鏡手術(shù) + 泌尿外科�。� 參考：《延邊大學(xué)》2017年碩士論文

【摘要】：目的:分析單孔腹腔鏡手術(shù)在泌尿外科中的臨床應(yīng)用及并發(fā)癥情況,為泌尿外科的患者選擇安全和有效的治療技術(shù)提供參考依據(jù)。方法:選取2014年9月至2016年9月在廊坊市人民醫(yī)院接受腹腔鏡下手術(shù)的泌尿外科患者98例,其中26例行腎腫瘤根治術(shù),24例行輸尿管切開取石術(shù),48例行腎囊腫去除術(shù)。全部患者分為觀察組(單孔腹腔鏡)49例,對照組(傳統(tǒng)腹腔鏡)49例。觀察各組患者的手術(shù)時間、切口大小、術(shù)中出血量、手術(shù)時氣道壓強(qiáng)均值、術(shù)后移除氣管導(dǎo)管時間、術(shù)后Hb下降幅度、術(shù)后住院天數(shù)、視覺模擬評分(VAS)、術(shù)后并發(fā)癥系統(tǒng)分級及皮下氣腫發(fā)生率。結(jié)果:1)兩組腎腫瘤根治術(shù)患者手術(shù)時間、切口大小、術(shù)中出血量、術(shù)后Hb下降幅度、術(shù)后住院天數(shù)、視覺模擬評分及術(shù)后并發(fā)癥系統(tǒng)分級均無統(tǒng)計(jì)學(xué)差異(P0.05)。觀察組手術(shù)時氣道壓強(qiáng)均值為(21.32±3.87)cmH2O,明顯低于對照組的(27.98±4.67)cmH20;術(shù)后移除氣管導(dǎo)管時間(19.79±2.36)min,明顯低于對照組的(34.23±3.11)min,皮下氣腫發(fā)生率為15.38%,低于對照組的30.77%,均具有統(tǒng)計(jì)學(xué)差異(P0.05)。2)兩組輸尿管切開取石術(shù)患者手術(shù)時間、術(shù)中出血量、術(shù)后Hb下降幅度、術(shù)后住院天數(shù)、視覺模擬評分及術(shù)后并發(fā)癥系統(tǒng)分級均無統(tǒng)計(jì)學(xué)差異(P/0.05)。觀察組的切口大小為(1.83±0.31)cm,明顯小于對照組的(3.15±0.52)cm;手術(shù)時氣道壓強(qiáng)均值為(18.77±2.25)cmH2O,明顯低于對照組的(23.92±4.13)cmH2O;術(shù)后移除氣管導(dǎo)管的用時(15.36±3.78)min,明顯低于對照組的(34.23±4.67)min;皮下氣腫發(fā)生率為8.33%,低于對照組的33.33%,均具有統(tǒng)計(jì)學(xué)差異(P0.05)。3)兩組腎囊腫去除術(shù)患者手術(shù)時間、術(shù)中出血量、術(shù)后Hb下降幅度、術(shù)后住院天數(shù)、視覺模擬評分及術(shù)后并發(fā)癥系統(tǒng)分級均無統(tǒng)計(jì)學(xué)差異(P0.05)。觀察組的切口大小為(1.46±0.54)cm,明顯小于對照組的(3.02±0.67)cm;手術(shù)時氣道壓強(qiáng)均值為(17.89±2.47)cmH2O,明顯低于對照組的(21.95±3.35)c,H2O;手術(shù)后移除氣管導(dǎo)管的用時(24.68±7.99)min,明顯低于對照組的(44.23±4.82)min;皮下氣腫發(fā)生率為0,低于對照組的16.67%,均具有統(tǒng)計(jì)學(xué)差異(PP0.05)。結(jié)論:單孔腹腔鏡下泌尿外科手術(shù)安全可靠,并且能夠降低皮下氣腫發(fā)生率,減小患者的氣道受損的可能,減短麻醉蘇醒用時,同時還能提高美觀性,具有較好的治療效果,有一定的臨床應(yīng)用價值,值得推廣。
[Abstract]:Objective: to analyze the clinical application and complications of single hole laparoscopic surgery in the Department of urology. To provide a reference basis for selecting safe and effective treatment techniques for patients in the Department of urology. Methods: 98 cases of patients received laparoscopic hand surgery in Langfang People's Hospital from September 2014 to September 2016 were selected, of which 26 were treated with nephrectomy. Radical resection of the tumor, 24 cases of ureterolithotomy and 48 cases of renal cyst removal were performed. All the patients were divided into the observation group (single hole laparoscope) 49 cases and the control group (traditional laparoscopy) 49 cases. The operation time, the size of the incision, the amount of bleeding during the operation, the mean airway pressure in the operation, the time of the tracheal catheter removal after operation, and the decrease of Hb after the operation were observed. Postoperative hospital days, visual analogue scale (VAS), postoperative complications system classification and subcutaneous emphysema incidence. Results: 1) two groups of renal tumor radical operation time, incision size, intraoperative bleeding, postoperative Hb decline, postoperative hospital days, visual analogue evaluation and postoperative complications system classification were no significant difference (P0.05). The mean airway pressure of the group was (21.32 + 3.87) cmH2O, which was significantly lower than that of the control group (27.98 + 4.67) cmH20, and the time of tracheal catheter removal (19.79 + 2.36) min after operation was significantly lower than that of the control group (34.23 + 3.11) min, and the incidence of subcutaneous emphysema was 15.38%, lower than 30.77% of the control group (P0.05).2) and the two ureterotomy was taken. The operation time, intraoperative bleeding, postoperative Hb decline, postoperative hospital stay, visual analogue scale and postoperative complications system classification were not statistically different (P/0.05). The incision size of the observation group was (1.83 + 0.31) cm, obviously less than that of the control group (3.15 + 0.52) cm; the mean airway pressure in the operation was (18.77 + 2.25) cmH2O, obviously lower. In the control group (23.92 + 4.13) cmH2O, the removal of tracheal catheter after operation (15.36 + 3.78) min was significantly lower than that of the control group (34.23 + 4.67) min; the incidence of subcutaneous emphysema was 8.33%, lower than 33.33% of the control group, and all had statistical difference (P0.05).3) the operation time, the amount of intraoperative hemorrhage, and the decrease of Hb after operation in the two group of renal cysts were performed. The postoperative hospital days, visual analogue scale and postoperative complications system classification were not statistically different (P0.05). The incision size of the observation group was (1.46 + 0.54) cm, obviously less than that of the control group (3.02 + 0.67) cm, and the mean airway pressure was (17.89 + 2.47) cmH2O during the operation, which was significantly lower than that of the control group (21.95 + 3.35) C, H2O; the use of tracheal catheter after operation The rate of (24.68 + 7.99) min was significantly lower than that of the control group (44.23 + 4.82) min, and the incidence of subcutaneous emphysema was 0, which was lower than 16.67% of the control group (PP0.05). Conclusion: the single hole laparoscopic Department of Urology operation is safe and reliable, and it can reduce the incidence of subcutaneous emphysema, reduce the possibility of airway damage in the patients, and reduce the use of anesthesia recovery. At the same time, at the same time, it can also improve the beauty, has good therapeutic effect, has certain clinical application value, and is worthy of promotion.
【學(xué)位授予單位】：延邊大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R699

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