经阴道自然腔道内镜辅助腹腔镜与标准腹腔镜肾部分切除术的安全性及围手术期护理比较

Safety and perioperative care of hybrid transvaginal NOTES laparoscopic versus standard laparoscopic partial nephrectomy

目的探讨经阴道自然腔道内镜辅助腹腔镜肾部分切除术的安全性、优势及围手术期护理经验。方法回顾性分析我院2013年8月~2016年1月经阴道自然腔道内镜辅助腹腔镜肾部分切除术14例患者的临床资料,设为研究组,同时选取同期标准腹腔镜肾部分切除术16例,设为对照组。比较两组患者围术期手术室术前护士准备时间、术中手术时间、术中出血量、术后拔管时间、中转开腹率、术后视觉模拟疼痛评分(VAS)、术后瘢痕问卷评分(PSAQ)及术后住院时间的差异。结果两组患者均顺利完成手术。术前准备时间、手术时间、术中出血量、术后拔管时间两组比较差异无统计学意义(P>0.05),未中转开放手术或新增工作通道,两组中转开腹率比较差异无统计学意义(P>0.05)。VAS、PSAQ评分及术后住院时间比较差异有统计学意义(P<0.05)。术后随访3~30个月,患者均健康存活,无肿瘤复发。结论经阴道自然腔道内镜辅助腹腔镜肾部分切除术是一种安全可靠的新术式,具有更加微、疼痛轻、术后恢复更快、美容效果更佳的优势。充分的术前准备,熟练的手术配合及细致的术后护理,均是手术安全、成功重要保障。

Objective To explore the safety,advantages and perioperative nursing experience of hybrid transvaginal NOTES laparoscopie partial nephrectomy.Methods The clinical data of 14 patients who underwent hybrid transvaginal NOTES laparoscopic partial nephrectomy from August 2013 to January 2016 were retrospectively analyzed as the study group, and 16 patients who underwent standard laparoseopic partial nephrectomy as the control group.The preoperative nurse preparation time,the operation time,the intraoperative blood loss,the postoperative drainage tube extubating time,the rate of conversion to open surgery,the postoperative Visual Analogue Scale （VAS） and Patient Scar Assessment Questionnaire and Scoring System （PSAQ） and the postoperative hospital stay were compared between the two groups.Results All the operations were successfully completed in twogroups.There were no significant differences in the preoperative nurse preparation time,operation time,intraoperative blood loss,postoperative drainage tube extubating time and rate of conversion to open surgerybetween the two groups （P〉0.05）.No patients required conversion to open surgery and adding trocars.There were significant differences in the VAS,PSAQ and postoperative hospital stay between the two groups （P〈0.05）.All the pa- tients were followed up from 3 to 30 months,patients survived without tumor recurrence.Conclusion Hybrid transvaginal NOTES laparoscopic partial nephrectomy is a safe and reliable new procedure without increasing the labor intensity of theoperating room nurses.Compared with the standard par- tial laparoscopic partial nephrectomy,It is worthy of clin- ical application with more minimally invasive,less pain, faster postoperative recovery and better cosmetic results.