Gibson切口在后腹腔镜下肾盂癌根治术中的应用研究

Application of Gibson Incision in Retroperitoneal Laparoscopic Resection for Renal Pelvis Carcinoma

目的探讨Gibson切口在后腹腔镜下肾盂癌根治术中的临床应用价值。方法回顾性分析56例经后腹腔镜下肾盂癌根治术患者的临床资料,对术中切除患侧中下段输尿管及部分膀胱的入路进行比较。采用Gibson切口入路（Gibson切口）31例,采用下腹部正中切口入路（正中切口组）25例,比较两组手术时间、平均术中出血量、术后膀胱激惹症状、术后漏尿、术后下床活动时间、切口种植转移、切口感染发生、术后切口瘢痕长度等指标。结果术中经后腹腔镜下切除患肾后开始计算,Gibson切口组平均手术时间36（25-56）min。平均出血量35（20-80）ml;术后膀胱激惹症状3例;平均术后下床活动时间1.5（1-2）d;无术后漏尿;无切口肿瘤种植转移及感染发生。术后平均切口瘢痕长度4.9（4.0-6.4）cm。正中切口组平均手术时间61（45-78）min;平均出血量70（60-95）ml;术后膀胱激惹症状13例;平均术后下床活动时间2.5（2-4）d;术后切口感染及漏尿各3例;无切口肿瘤种植转移;术后平均切口瘢痕长度7.1（6.0.-8.5）cm。Gibson切口组平均手术时间、术中出血量、术后膀胱刺激症状发生、术后下床活动时间及切口瘢痕长度明显优于正中切口组（P〈0.05）。结论 Gibson切口在后腹腔镜下肾盂癌根治术中处理中下段输尿管及膀胱袖套状切除具有微创、可靠、安全等优点。

Objective To investigate the clinical value of Gibson incision in retroperitoneal laparoscopic resection for re-nal pelvic carcinoma.Methods Clinical data of 56 cases of retroperitoneal laparoscopic resection of renal pelvis carcinoma were retrospectively analyzed.31 cases treated with Gibson incision approach （ Gibson） ,25 cases treated with lower abdominal median incision （median incision group）,operation time,bleeding volume,postoperative bladder irritation symptoms,postoperative leak-age of urine,postoperative bed activity time,incision implantation,incision infection,postoperative incision scar length and other indicators were compared.Results After retroperitoneal laparoscopic resection of the kidney,the average operation time was 36 （25-56） min in Gibson group.Average bleeding volume was 35（20-80） ml.Postoperative bladder irritation symptoms in 3 ca-ses,the average postoperative activity time was 1.5 （1-2） d.There had no postoperative leakage of urine;no incision tumor me-tastasis and infection.The average incision scar length was 4.9 （4.0-6.4） cm.Median incision group,the average operation time was 61 （45-78） min.Average bleeding volume 70 （60-95） ml.Postoperative bladder irritation symptoms in 13 cases,the average postoperative activity time was 2.5（2-4） d.Postoperative wound infection and leakage of urine in 3 cases.There had no incision tumor implantation.The average incision scar length was 7.1（6.0.-8.5） cm.The average operation time,bleeding vol-ume,postoperative bladder irritation symptoms,postoperative activity time and the length of the incision scar were superior to those of the median incision group （P〈0.05）.Conclusion Gibson incision in retroperitoneal laparoscopic renal pelvis cancer radical operation in the treatment of middle and low ureteral and bladder cuff resection is minimally invasive,reliable and safe.