發(fā)布時(shí)間：2018-03-18 11:14

  本文選題：中央型腎腫瘤　切入點(diǎn)：后腹腔鏡下腎部分切除術(shù)　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的目前外周型腎腫瘤采用腹腔鏡下腎部分切除術(shù)治療已經(jīng)在臨床廣泛地開展,而中央型腎腫瘤由于位置深并且靠近腎蒂血管和集合系統(tǒng),手術(shù)難度相對(duì)較大,對(duì)腹腔鏡腎部分切除技術(shù)要求高,在現(xiàn)階段仍是一項(xiàng)充滿技術(shù)挑戰(zhàn)性的手術(shù)。經(jīng)后腹腔途徑的腹腔鏡腎部分切除術(shù)在手術(shù)持續(xù)時(shí)間、手術(shù)出血量和手術(shù)并發(fā)癥方面有較大的優(yōu)勢(shì),因此我們分析后腹腔鏡下腎部分切除術(shù)治療中央型腎腫瘤的安全性和可行性。資料與方法我們收集了 2014年12月到2016年6月期間在山東大學(xué)齊魯醫(yī)院泌尿外科行后腹腔鏡下腎部分切除術(shù)的患者資料。將61例按標(biāo)準(zhǔn)納入研究對(duì)象,其中中央型腎腫瘤患者10例,外周型腎腫瘤患者51例。對(duì)比研究采集的信息:患者性別、年齡、體重指數(shù)、ASA分級(jí)、熱缺血時(shí)間、手術(shù)時(shí)間、術(shù)中出血量、腫瘤位置、腫瘤病理直徑、腫瘤病理類型、腫瘤的Fuhrman分級(jí)、圍手術(shù)期并發(fā)癥、術(shù)前血清肌酐、術(shù)后血清肌酐、腎小球?yàn)V過率下降等,并通過問卷評(píng)分的方式評(píng)估了手術(shù)醫(yī)師工作負(fù)荷、技術(shù)操作難度、表現(xiàn)滿意度、時(shí)間壓力以及配合手術(shù)護(hù)理人員的工作負(fù)荷等各指標(biāo)。采用SPSS 22.0統(tǒng)計(jì)軟件對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析。使用Kolmogorov-Smirnov方法檢驗(yàn)計(jì)量數(shù)據(jù)的正態(tài)性,如果計(jì)量數(shù)據(jù)呈現(xiàn)正態(tài)分布趨勢(shì),則使用獨(dú)立樣本t檢驗(yàn)。有序變量或者不符合正態(tài)分布的數(shù)據(jù),采用Mann-Whitney U秩和檢驗(yàn),無序分類變量使用卡方檢驗(yàn)或者Fisher確切概率法檢驗(yàn),以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果兩組患者的年齡、體重指數(shù)、性別等術(shù)前資料均無差異統(tǒng)計(jì)學(xué)意義。61例手術(shù)均在全麻下順利完成,術(shù)中沒有手術(shù)方式的轉(zhuǎn)換。中央型腎腫瘤組的平均手術(shù)時(shí)間175.0±23.2min,熱缺血時(shí)間25.8±3.0min,失血量97.9±22.8ml;術(shù)后并發(fā)癥ClavienⅠ級(jí)2例,腎小球?yàn)V過率下降百分?jǐn)?shù)為9.5±7.1%。外周型腎腫瘤組的平均手術(shù)時(shí)間139.7±30.6min,熱缺血時(shí)間19.1±3.9min,失血量91.6±66.1ml,術(shù)后并發(fā)癥ClavienⅠ級(jí)9例、Ⅱ級(jí)2例,腎小球?yàn)V過率下降百分?jǐn)?shù)為5.9±11.2%。兩組在手術(shù)時(shí)間和手術(shù)熱缺血時(shí)間比較有差異統(tǒng)計(jì)學(xué)意義,中央型腎腫瘤組的手術(shù)時(shí)間和熱缺血時(shí)間均顯著長于外周型腎腫瘤組。在手術(shù)中失血量、腫瘤最大直徑、術(shù)后腫瘤病理類型、腫瘤Furman分級(jí)、術(shù)后并發(fā)癥、腎小球?yàn)V過率下降上比較均無差異統(tǒng)計(jì)學(xué)意義。對(duì)手術(shù)者而言,中央型腎腫瘤組的工作負(fù)荷要明顯高于外周型腎腫瘤組(3.10±0.74 vs.2.12±0.79),中央型腎腫瘤組的技術(shù)操作難度要明顯高于外周型腎腫瘤組(3.10±0.57 vs.2.37±0.75);而在表現(xiàn)滿意度和時(shí)間壓力上兩組之間均無明顯差異。對(duì)護(hù)理人員而言,兩組在工作負(fù)荷上無顯著差異。結(jié)論我們認(rèn)為后腹腔下腎部分切除術(shù)治療中央型腎腫瘤是一種安全有效的手術(shù)方式,值得在臨床上推廣應(yīng)用。
[Abstract]:Objective Laparoscopic partial nephrectomy has been widely used in the treatment of peripheral renal neoplasms, while central renal tumor is difficult because of its deep location and close to the renal pedicle vessels and collecting system. Laparoscopic partial nephrectomy is a technically challenging procedure at this stage. Laparoscopic partial nephrectomy via retroperitoneal approach lasts for a long time. The amount of blood lost and the complications of the operation have great advantages. Therefore, we analyzed the safety and feasibility of retroperitoneal laparoscopic partial nephrectomy in the treatment of central renal neoplasms. Data and methods We collected the urological department of Qilu Hospital, Shandong University from December 2014 to June 2016. Data of patients undergoing retroperitoneal laparoscopic partial nephrectomy. 61 patients were included in the study according to the criteria. There were 10 patients with central renal tumor and 51 patients with peripheral renal tumor. The information collected from the comparative study was as follows: gender, age, body mass index (BMI) ASA grade, warm ischemia time, operative time, intraoperative bleeding volume, tumor location. Tumor pathological diameter, tumor pathological type, tumor Fuhrman grade, perioperative complications, preoperative serum creatinine, postoperative serum creatinine, decreased glomerular filtration rate, etc. The technical operation difficulty, performance satisfaction, time pressure and workload of nursing staff were analyzed with SPSS 22.0 software. Kolmogorov-Smirnov method was used to test the normality of measurement data. If the measurement data show a trend of normal distribution, then the independent sample t test is used. The ordered variables or data that do not conform to the normal distribution are tested by Mann-Whitney U rank sum test, the unordered classification variables are tested by chi-square test or Fisher exact probability test. Results there was no significant difference in age, body mass index, sex and other preoperative data between the two groups. 61 cases of operation were successfully completed under general anesthesia. There was no change of operative mode during the operation. The mean operative time, hot ischemia time and blood loss were 175.0 鹵23.2min, 25.8 鹵3.0min, 97.9 鹵22.8 ml, respectively, and the postoperative complications were Clavien 鈪，

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