本文選題：手助腹腔鏡 + 腎切除��； 參考：《山東大學(xué)》2014年碩士論文

【摘要】：目的： 探討手助腹腔鏡中使用腔內(nèi)直線切割吻合器(Endo GIA)和威克外科結(jié)扎鎖(Hem-O-lok)截斷腎血管的安全性及經(jīng)濟(jì)性。 材料及方法： 本次研究我們回顧性的分析了山東省立醫(yī)院泌尿微創(chuàng)腎移植科自2010年1月至2013年9月共49例接受手助腹腔鏡腎癌根治術(shù)的患者資料。27-72歲,平均年齡52.6±10.6歲；左側(cè)病變27例,右側(cè)22例,均經(jīng)B超及強(qiáng)化CT檢查診斷為腎癌,其中2例合并腎靜脈癌栓。49例患者均采用經(jīng)腹腔的手助腹腔鏡腎癌根治術(shù),根據(jù)術(shù)中處理腎蒂方法的不同,我們將49例患者分為：A組：使用腔內(nèi)直線切割吻合器同時截斷腎動、靜脈(21例)；B組：威克外科結(jié)扎鎖分別截斷腎動、靜脈(28例,腎靜脈癌栓2例)。統(tǒng)計所有病例術(shù)中及圍手術(shù)期的相關(guān)數(shù)據(jù),并對住院期間相關(guān)費用進(jìn)行統(tǒng)計分析,評估Endo GIA和Hem-0-lok的安全性及經(jīng)濟(jì)性。 結(jié)果： 49例手術(shù)過程均順利,無中途轉(zhuǎn)開放手術(shù),術(shù)中及術(shù)后無明顯血管并發(fā)癥,B組2例腎靜脈癌栓患者均在術(shù)中成功取栓。兩組術(shù)中平均出血分別為78.3ml和92.1ml(P=0.244),手術(shù)平均時間分別為75.7min和94.1min(P=0.059),術(shù)后平均住院天數(shù)分別為7.52d和7.29d(P=0.761),術(shù)后第一日引流量平均值分別為145.76ml和172.54ml(P=0.143),均無顯著性差異。術(shù)后前三日引流量分別為282.67ml和403.35ml(P=0.018),所用耗材費用平均值分別為3651.90元和2781.43元(P=0.008)有顯著性差異。 結(jié)論： 手助腹腔鏡腎切除術(shù)中用腔內(nèi)直線切割吻合器(Endo GIA)和威克外科結(jié)扎鎖(Hem-O-lok)處理腎蒂血管安全性均較可靠。但使用Hem-O-lok對周圍組織損傷較切割吻合器大,術(shù)者需要根據(jù)經(jīng)驗進(jìn)行精細(xì)處理。對于有經(jīng)驗的外科醫(yī)師使用Hem-O-lok則更經(jīng)濟(jì),是不錯的選擇。
[Abstract]:Objective: to investigate the safety and economy of endolumbar wire incision stapling (Endo GIAA) and surgical ligation of Hem-O-lok (Hem-O-lok) in hand-assisted laparoscopy. Materials and methods: in this study, we retrospectively analyzed the data of 49 patients undergoing hand-assisted laparoscopic radical nephrectomy from January 2010 to September 2013 in the Department of Urology and minimally invasive Kidney Transplantation, Shandong Provincial Hospital. The mean age was 52.6 鹵10.6 years, the left lesions were 27 cases, the right side 22 cases, all of them were diagnosed as renal cell carcinoma by B-ultrasound and enhanced CT, among them, 2 cases were complicated with renal vein carcinoma thrombus. 49 cases were treated with intraperitoneal hand-assisted laparoscopic radical nephrectomy. According to the different methods of dealing with renal pedicle during operation, 49 cases were divided into two groups: group A (n = 28), group B (n = 21) treated with intracavitary straight wire incision stapler and group B (n = 21): the renal artery was truncated by surgical ligation lock, and 28 cases by vein anastomosis. Renal vein tumor embolus in 2 cases. To evaluate the safety and economy of Endo GIA and Hem-0-lok, the relevant data of all cases during operation and perioperative period were analyzed. Results: the procedure of 49 cases was smooth, there was no midway to open operation. In group B, 2 patients with renal vein tumor thrombus were successfully removed during the operation without obvious vascular complications. The average intraoperative bleeding was 78.3ml and 92.1ml / L Pu 0.244g, the average operation time was 75.7min and 94.1min P0. 059m respectively, the average hospitalization days were 7.52 days and 7.29days respectively. The average drainage volume on the first day after operation was 145.76ml and 172.54mlP0.143, respectively. There was no significant difference between the two groups. For the first three days after operation, the drainage volume was 282.67ml and 403.35 ml / L, respectively, and the average cost of the consumables was 3651.90 yuan and 2781.43 yuan respectively. There was significant difference between the two groups. Conclusion: Endo GIAs and Hem-O-lok in hand-assisted laparoscopic nephrectomy are safe for the treatment of renal pedicle vessels. But using Hem-O-lok to injure the surrounding tissue is more serious than cutting stapler, so the operator needs to deal with it carefully according to experience. Hem-O-lok is more economical and a good choice for experienced surgeons.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R737.11

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