【摘要】：目的比較三維腹腔鏡與標(biāo)準(zhǔn)腹腔鏡下腎部分切除術(shù)的臨床資料,探討三維腹腔鏡下腎部分切除術(shù)的安全性、可行性和優(yōu)缺點(diǎn)。方法回顧性分析2012年1月—2015年3月收治的49例局限性腎腫瘤患者的臨床資料,男31例、女18例,平均年齡為(55.5±12.5)歲,腫瘤位于左側(cè)腎臟26例、右側(cè)腎臟23例,手術(shù)入路為經(jīng)腹腔途徑16例、經(jīng)后腹腔途徑33例。根據(jù)手術(shù)方法將患者分為三維腹腔鏡組(3D組,20例)和標(biāo)準(zhǔn)腹腔鏡組(標(biāo)準(zhǔn)組,29例)。比較兩組手術(shù)參與者的視覺滿意度、操作適應(yīng)度、頭暈不適度、眼睛疲勞度評分。比較兩組患者的手術(shù)時間、術(shù)中失血量、熱缺血時間、術(shù)后腸道通氣恢復(fù)時間、術(shù)后住院天數(shù),以及兩組術(shù)后1個月雙側(cè)腎臟腎小球?yàn)V過率(GFR)。結(jié)果兩組手術(shù)均成功完成,無中轉(zhuǎn)開放手術(shù)病例。3D組視覺滿意度、操作適應(yīng)度和總體滿意度評分均顯著高于標(biāo)準(zhǔn)組(P值均0.05),兩組間頭暈不適度和眼部疲勞度評分的差異均無統(tǒng)計學(xué)意義(P值均0.05)。兩組間手術(shù)時間、術(shù)中失血量、術(shù)中熱缺血時間、術(shù)后腸道通氣恢復(fù)時間、術(shù)后住院天數(shù)和并發(fā)癥發(fā)生率的差異均無統(tǒng)計學(xué)意義(P值均0.05)。兩組術(shù)后隨訪4~41個月,無1例患者發(fā)生復(fù)發(fā)和轉(zhuǎn)移。兩組術(shù)后1個月患側(cè)腎臟GFR均較術(shù)前顯著降低(P值均0.05),健側(cè)腎臟GFR均較術(shù)前顯著升高(P值均0.05);兩組間患側(cè)和健側(cè)腎臟手術(shù)前后GFR差值的差異均無統(tǒng)計學(xué)意義(P值均0.05)。結(jié)論應(yīng)用三維腹腔鏡技術(shù)行腎部分切除手術(shù)安全、可行;與標(biāo)準(zhǔn)腹腔鏡相比,三維腹腔鏡技術(shù)在視覺上和精細(xì)操作上可能具有一定的優(yōu)勢。
[Abstract]:Objective to compare the clinical data of three-dimensional laparoscopic partial renal resection with that of standard laparoscopic partial renal resection, and to explore the safety, feasibility, advantages and disadvantages of three-dimensional laparoscopic partial renal resection. Methods the clinical data of 49 patients with localized renal tumors from January 2012 to March 2015 were analyzed retrospectively. there were 31 males and 18 females with an average age of (55.5 鹵12.5) years. The tumors were located in the left kidney in 26 cases and in the right kidney in 23 cases. The surgical approach was abdominal approach in 16 cases and posterior abdominal approach in 33 cases. According to the surgical method, the patients were divided into three-dimensional laparoscopy group (3D group, 20 cases) and standard laparoscopy group (standard group, 29 cases). The visual satisfaction, operation fitness, dizziness and eye fatigue were compared between the two groups. The operation time, intraoperative blood loss, warm ischemia time, postoperative intestinal ventilation recovery time, postoperative hospitalization days, and bilateral renal glomerular filtration rate (GFR). 1 month after operation were compared between the two groups. Results the operation was successfully completed in both groups. There were no cases of conversion to open surgery. Visual satisfaction, operation fitness and overall satisfaction score in 3D group were significantly higher than those in standard group (P 0.05). There was no significant difference in dizziness and eye fatigue score between the two groups (P 0.05). There were no significant differences in operation time, intraoperative blood loss, intraoperative warm ischemia time, postoperative intestinal ventilation recovery time, postoperative hospitalization days and incidence of complications between the two groups (P 0.05). The patients in the two groups were followed up for 4 months and 41 months, and no recurrence and metastasis occurred in none of the patients. One month after operation, the GFR of the affected side was significantly lower than that before operation, and the GFR of the healthy side was significantly higher than that before operation. There was no significant difference in GFR difference between the two groups before and after renal operation. Conclusion it is safe and feasible to use three-dimensional laparoscopy for partial resection of kidney, and compared with standard laparoscopy, three-dimensional laparoscopy may have some advantages in vision and fine operation.
【作者單位】： 上海長征醫(yī)院泌尿外科;上海長海醫(yī)院泌尿外科;
【基金】：上海市科技人才計劃(13XD1400100) 國家科技重大專項(xiàng)(2012ZX09303011-002) 國家自然科學(xué)基金面上項(xiàng)目(81272817,81172447) 上海市自然科學(xué)基金(11ZR1447800)項(xiàng)目資助
【分類號】：R737.11

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