腹膜后腹腔镜技术在泌尿外科的应用

Development of Retroperitoneal Laparoscopy Technology in the Urinary Surgery

目的:对比腹膜后腹腔镜手术起步阶段和相对成熟阶段的临床资料,总结手术经验,提高应用水平。方法:对2005年1月至2008年12月起步阶段腹膜后腹腔镜手术65例患者,及2016年1月至2016年12月相对成熟阶段腹膜后腹腔镜手术148例患者进行回顾性分析。结果:起步阶段:中转开放手术5例,术后发热及切口延迟愈合7例;相对成熟阶段:中转开放手术4例,术后发热及切口延迟愈合6例,无大血管破裂、腹腔内脏器损伤、死亡等并发症。在肾囊肿去顶减压手术及肾上腺手术中,成熟阶段患者的各项指标包括手术时间、出血量、中转开放手术比例、术后拔除引流管时间及住院时间均显著优于起步阶段,差异有统计学意义(P<0.05)。结论:腹膜后腹腔镜技术适于治疗上尿路及肾上腺疾病,具有患者创伤小、安全、术后康复快等优点,早期起步阶段适合选择简单术式,随着手术技术的熟练可逐步开展复杂的手术。

Objective： To compare the clinical data of the initial stage and the relatively mature stage of retroperitoneoscopic surgery, summarize the surgical experience and improve the application level. Methods： 64 cases in the initial stage from January 2005 to December 2008 and 148 cases in the relatively mature stage from January 2016 to December 2016 underwent retroperitoneoscopic surgery were analyzed retrospectively. Results： In the early stage, 5 cases converted to an open surgical procedure and postoperative fever, oliguria and delayed healing of incision occurred in 7 cases. In the relatively mature stage, 4 cases converted to an open surgical procedure and postoperative fever, oliguria and delayed healing of incision occurred in 6 cases. No large vessel or viscera damage hap- pened in the operation. In decompression of renal cysts and adrenal gland surgery, relatively mature stage of patients indexes including operation time, amount of bleeding, the percentage of open surgery, removal of drainage tube time and length of hospital stay were signif- icantly better than the beginning, the difference was statistically significant （P〈0.05）. Conclusion： Retroperitoneoscopic surgery is suit- able for treating upper urinary tract disease and adrenal gland diseases, with the advantages of lesser trauma, safety and rapid recovery. Simple operations could be chosen in the early stage, and complicated surgery should be developed gradually, with the improvement of surgical skills.