腹腔镜技术在泌尿外科中的应用

Application of laparoscopic technique in urology:a 10-year experience with 2,000 cases

目的总结第二军医大学附属长征医院采用腹腔镜技术处理泌尿外科疾患十余年2000例患者的经验。方法1999年1月—2009年9月,采用腹腔镜技术治疗泌尿系疾病患者2000例,手术均采用全身麻醉,采用后腹腔入路1821例,经腹腔入路179例;传统腹腔镜手术1949例(包括器官毁损、切除术1582例和器官保留、修复、重建术387例),单通道腹腔镜手术31例。结果手术一次成功率为96.7%(1934/2000),手术时间为35～480min,平均手术时间为(135±48)min;出血量为10～3500mL,平均出血量为(40±25)mL,需要输血的病例为138例,占全部病例的6.9%;平均住院时间为(8.1±4.6)d,随访3～120个月。合并症发生率为5.5%(110/2000),主要并发症为术中出血(2.6%,52/2000)、高碳酸血症(1.5%,29/2000)、切口感染(0.6%,12/2000)、后腹腔脓肿(0.2%,4/2000)及术后出血(0.45%,9/2000)等。结论传统腹腔镜手术技术已日益成熟,涉及泌尿外科的各种术式,可以达到满意的效果。单通道腹腔镜手术的切口更小,更美观,尽管操作难度较高,仍具有很大的推广应用价值。

Objective To summarize our 10-year experience （ about 2,000 cases） in using laparoscopic techniques for treatment of urological disorders in our center. Methods From Jan. 1999 to Sep. 2009, a total of 2,000 patients received laparoscopic surgery for urological disorders in our department under general anesthesia, with 1,821 via the retroperitoneal approach and 179 via transabdominal approach. Totally 1,949 cases received traditional laparoscopic surgery （including 1,582 cases with organ damage, resection and 387 cases with organ retention, restoration, and reconstruction） and 31 received single-port laparoscopic surgery. Results The success rate of surgery was 96.7%（1,934/2,000）, and the operation time was 35-480 min, with a mean of （135±48） min. The bleeding volume ranged 10-3,500 mL and veraged （40±25） mL. There were 138（6.9%） cases who required blood transfusion. The average hospitalization stays was （8.1±4.6） d and the follow-up was 3-120 months. Complication rate was 5.5% （110/2,000）, including bleeding （2.6%, 52/2,000）, hypercapnia （1.5%, 29/2,000）, wound infection （0.6%, 12/2,000）, abdominal Abscess （0.2%, 4/2,000）, postoperative bleeding （0.45%, 9/2,000）, et al. Conclusion Traditional laparoscopic surgical techniques become more sophisticated, and it can be used for a variety of urological surgery types, which can achieve satisfactory results. Single port laparoscopic surgery has smaller incision and is aesthetically preferred. Although the operation is more difficult, it is still worth popluarizing.