三维腹腔镜与传统腹腔镜下肾盂成形术的对照研究

Comparison of three dimensional and two dimentional laparoscopic pyeloplasty for ureteropelvic junction obstruction

目的 比较三维腹腔镜与传统腹腔镜下肾盂成形术的手术结果和技术特点.方法 回顾性分析2013年1月至2014年3月北京协和医院泌尿外科收治的31例行腹腔镜下肾盂成形术患者的临床资料.男性16例,女性15例;年龄21 ～42岁,平均（30±6）岁.左侧20例,右侧11例.术前均行B超及CT泌尿系成像检查明确诊断.按手术方法分为三维腹腔镜组（16例）和传统腹腔镜组（15例）.收集两组临床特点（性别、年龄、左右侧、体重指数）及围手术期数据（手术时间、出血量、术后住院时间、住院费用）.两组数据比较进行t检验,计数数据进行x2检验.结果 手术均成功,无中转开放手术.三维腹腔镜组手术时间为（106±16） min,明显短于传统腹腔镜组的（124 ±24）min,两者比较差异有统计学意义（t=5.993,P=0.021）.两组出血量[（54±14） ml比（57±16） ml,t=0.285,P=0.598]、术后住院时间[（7.3±0.7）d比（7.5±0.6）d,t=1.415,P=0.244]、并发症发生率（0/16比1/15,x2=1.102,P=0.484）、住院费用[（25 687 ±3 032）元比（25 426±2 626）元,t=0.065,P=0.800]比较差异均无统计学意义.患者均获得随访,随访时间3～12个月,平均6个月.三维腹腔镜组和传统腹腔镜组各有1例发生肾积水加重及再发狭窄,经治疗好转.结论 三维腹腔镜下肾盂成形术手术是安全、可行的.与传统腹腔镜手术相比,三维腹腔镜手术降低了手术的难度,明显缩短了手术时间.

Objective To compare clinical outcomes of three dimensional（3D） and traditional two dimentional （2D） laparoscopic pyeloplasty for ureteropelvic junction obstruction （UPJO）.Methods Clinical data on 31 patients who underwent retroperitoneoscopic pyeloplasty for UPJO in Peking Union Medical Hospital from January 2013 to March 2014 were retrospectively analyzed.There were 16 male and 15 female patients,and the age ranged from 21 to 42 years,mean （30 ±6） years.The lesions of 20 cases were located on the left side and 11 cases on the right side.All cases were diagnosed as UPJO by B ultrasound and computed tomography urography （CTU）.According to 3D or 2D laparoscopy,these patients were divided into two groups.The 3D laparoscopy group included 16 cases,who received 3D retroperitoneoscopic pyeloplasty.The 2D laparoscopy group included 15 cases,who received traditional 2D retroperitoneoscopic pyeloplasty.Demographic data（gender,age,laterality,body mass index）,perioperative indexes and clinical outcomes （operative time,estimated blood loss,postoperative hospital stay,total hospitalization charge）were collected and compared between two groups.Numerical demographic and perioperative data were analyzed by using Student＆#39;s t-test.Categorical data were compared using Pearson＆#39;s Chi-square test.Results All operations were completed successfully without open convertion.In the 3D laparoscopy group operative time was significantly shorter than 2D laparoscopy group （（106 ± 16） minutes vs.（124 ±24） minutes,t =5.993,P =0.021）.There were no significant difference between two groups on the estimated blood loss （（54 ± 14） ml vs.（57 ± 16） ml,t =0.285,P =0.598）,postoperative hospital stay （（7.3 ±0.7） days vs.（7.5 ±0.6） days,t =1.415,P =0.244）,incidence of postoperative complications （0/16 vs.1/15,x2 =1.102,P =0.484） and total hospitalization charge （（25 687 ±3 032） RMB vs.（25 426 ±2 626） RMB,t =0.065,P =0.800）.All patients were followed up from 3 to 12 months （mean 6 months）.Ureteropelvic junction stricture recurred in 2 cases respectively from 3D laparoscopic group and traditional laparoscopic group.Both were cured.Conclusions 3D laparoscopic pyeloplasty is safe and feasible.Compared with the traditional 2D laparoscopic technology,3D laparoscopy technology reduces the operation difficulty and shortens the operative time.