【摘要】：背景和目的隨著學(xué)科的發(fā)展,保留腎單位手術(shù)的療效已被認(rèn)可,且較廣泛的應(yīng)用于臨床,目前腹腔鏡已成為當(dāng)下流行的手術(shù)方法,其中3D腹腔鏡為近年來比較火熱的話題,而將其應(yīng)用于保留腎單位的手術(shù)中,其優(yōu)劣勢(shì)如何,各家數(shù)據(jù)不盡相同,因此對(duì)3D腹腔鏡及傳統(tǒng)腹腔鏡在保留腎單位手術(shù)行對(duì)比研究,比較其療效及使用價(jià)值。方法回顧性分析我院2013年8月至2016年12月收治的42例腎腫瘤行腹腔鏡保留腎單位手術(shù)的臨床資料,其中3D腹腔鏡組22例和傳統(tǒng)腹腔鏡組20例。2組患者年齡、性別、腫瘤左右側(cè)、腫瘤大小均無統(tǒng)計(jì)學(xué)差異。分析比較二組臨床資料的手術(shù)時(shí)間、熱缺血時(shí)間、術(shù)中出血量、住院費(fèi)用和并發(fā)癥發(fā)生情況。結(jié)果二組手術(shù)均成功順利完成,無一例中轉(zhuǎn)開放手術(shù)者。傳統(tǒng)組和3D組的手術(shù)時(shí)間分別為(125.70±9.30)min、(111.55±9.05)min,差異有統(tǒng)計(jì)學(xué)意義(P0.05);熱缺血時(shí)間分別為(29.45±5.53)min、(26.14±4.57)min,差異有統(tǒng)計(jì)學(xué)意義(P0.05);住院費(fèi)用分別為(1.93±0.11)萬元、(1.99±0.12)萬元,差異無統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)中出血量分別為(97.90±9.07)ml、(91.73±10.68)ml,差異無統(tǒng)計(jì)學(xué)意義(P0.05);2組均有1例切口延遲愈合,保守治療后均治愈。術(shù)后病理示:所有手術(shù)切緣均陰性;手術(shù)標(biāo)本中透明細(xì)胞癌31例,血管平滑肌脂肪瘤8例,囊性腎細(xì)胞癌1例,嫌色細(xì)胞癌2例。隨訪6~48個(gè)月,未見復(fù)發(fā)和轉(zhuǎn)移,腎功能檢查未見異常。結(jié)論二組手術(shù)方式在保留腎單位手術(shù)上都是安全有效的微創(chuàng)術(shù)式。傳統(tǒng)腹腔鏡推廣簡(jiǎn)單,投入費(fèi)用少,應(yīng)用廣泛;3D腹腔鏡在空間定位及深度感上有明顯的三維優(yōu)勢(shì),其立體視野使得游離、縫合等手術(shù)操縱更易于進(jìn)行,同時(shí)有著可觀的經(jīng)濟(jì)性,使其在泌尿外科手術(shù)領(lǐng)域有著廣闊的應(yīng)用前景。
[Abstract]:Background and objective with the development of science, the curative effect of nephron sparing surgery has been recognized, and widely used in clinical practice. At present, laparoscopy has become a popular surgical method, among which 3D laparoscopy is a hot topic in recent years. However, the merits and demerits of renal unit sparing surgery are different from each other. Therefore, a comparative study of 3D laparoscopy and traditional laparoscopy in renal unit sparing surgery is carried out to compare the curative effect and practical value. Methods the clinical data of 42 patients with renal tumor undergoing laparoscopic nephron-sparing surgery from August 2013 to December 2016 were retrospectively analyzed, including 22 cases in 3D laparoscopic group and 20 cases in traditional laparoscopic group. There was no significant difference in tumor size between the right and left sides. The time of operation, the time of hot ischemia, the amount of intraoperative bleeding, the cost of hospitalization and the occurrence of complications were analyzed and compared between the two groups. Results all the operations were successfully completed in both groups, none of them were transferred to open operation. The operative time of traditional group and 3D group were (125.70 鹵9.30) min, (111.55 鹵9.05) min, significantly different (P0.05). The time of hot ischemia was (29.45 鹵5.53) min, (26.14 鹵4.57) min, (P0.05). The hospitalization expenses were (1.93 鹵0.11) yuan and (1.99 鹵0.12) yuan, respectively. The difference was not statistically significant (P0.05). There was no significant difference in intraoperative bleeding volume (97.90 鹵9.07) ml, (91.73 鹵10.68) ml, (P0.05). All the surgical margins were negative, 31 cases of clear cell carcinoma, 8 cases of angiomyolipoma, 1 case of cystic renal cell carcinoma and 2 cases of chromophobe cell carcinoma. Follow-up for 6 ~ 48 months showed no recurrence or metastasis and no abnormal renal function. Conclusion both groups are safe and effective minimally invasive procedures for nephron-sparing surgery. The traditional laparoscopy is simple to popularize, has less input cost and is widely used. 3D laparoscopy has obvious advantages in spatial location and depth sense, and its stereoscopic visual field makes free, suture and other surgical manipulation easier, and has considerable economy. It has a broad application prospect in the field of urological surgery.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.11

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