3种后腹腔镜建腔方式在泌尿外科手术中的应用

Three different ways of establishing retroperitoneal space in urologic surgery

目的比较泌尿外科后腹腔镜建立后腹腔的3种方式的耗时、安全性、术中术后并发症以及对手术操作的影响。方法 2010年12月~2012年12月,对施行后腹腔镜术的810例患者,按建腔方式的不同,随机分为A、B、C3组。A组采用自制气囊法建立后腹腔;B组采用手指分离法建立后腹腔;C组采用北京大学泌尿外科研究所的IUPU法（Istitute of Urology,Peking University）,建立后腹腔。分别记录建腔时间、统计术中术后并发症、评价对手术操作的影响及跟踪随访Trocar切口愈合情况等。结果除A组因1例气囊破裂改为开放手术外,其余均可顺利建立后腹膜腔。建立起的后腹腔均足够大,对手术操作无明显影响。A、B、C3组建立后腹腔的时间分别为：A组（7.3±3.2）min,B组（4.8±2.8）min,C组（3.7±1.8）min,三组间比较时间差异有显著性（P〈0.05）。3组患者的曲卡切口均愈合良好。但气囊组14例患者术后患侧腰肋部外凸,无明显不适。3组术后均无明显并发症。结论 IUPU法最为简便、省时且切口也最小;气囊法最耗时,气囊有破裂的风险,且术后可能出现患侧腰肋部外凸;而手指法在上述优劣性上介于两者之间。在泌尿外科后腹膜腔建腔中,可采用简便省时的IUPU法,而传统的气囊法并无优势。

[Objective]To compare the establishing time, security, intra-postoperative complications of three different ways of establishing the retroperitoneal space in urologic surgery.[Methods]From December 2010 to December 2012, 810 patients were performed laparoscopy via retroperitoneal approach. According to the different ways of establishing the retroperitoneal space, they wre separated into three groups randomly： group A, B and C. Group A uesd balloon technique to build up the retroperitoneal space, group B uesd finger separation technique, group C uesd IUPU（the acronym of Institute of Urology, Peking University） technique. We recorded the establishing time, intrapostoperative complications, evaluated the effect on surgery and followed up the wound healing.[Results]All cases were successful in establishing the retroperitoneal space except one in group A, which was converted to open surgery because of balloon burst. The space we builded was big enough for surgery. The establishing time was（7.3±3.2） min（group A）,（4.8±2.8） min（group B） and（3.7 ±1.8） min（group C）, the difference had statistical significance. All the incisions were healed well. However, 14 cases in group A had waist bulging after surgery with no obviously uncomfortable. There were no significant post-operative complications in all cases. [Conclusion]IUPU technique was simple, convenient and time-saving with smaller incision. The balloon technique took longer time with the problem of balloon burst and waist bulging, while the finger technique between them. So, we could use the IUPU technique to expand retroperitoneal space in the future, while the traditional balloon technique confirmed no advantage.