气腹针辅助膀胱腹膜悬吊法在腹腔镜下膀胱根治性切除手术中的应用

Application of Pneumoperitoneal Needle Assisted Bladder Peritoneal Suspension Method in Laparoscopic Radical Cystectomy

目的比较采用一次性使用气腹针联合带线一次性使用组织闭合夹辅助悬吊膀胱腹膜方式(下面简称膀胱腹膜悬吊法)与采用常规助手辅助牵拉膀胱腹膜方式行腹腔镜下根治性膀胱切除术治疗膀胱癌的术中应用效果及临床疗效。方法回顾性分析我院泌尿外科2016年7月至2019年7月期间行腹腔镜下根治性膀胱切除术的60例膀胱恶性肿瘤患者临床资料。按照术中操作方法不同分为两组,观察组20例,采用膀胱腹膜悬吊法进行手术;对照组40例,采用常规助手辅助牵拉膀胱腹膜方式进行手术,比较两组的一般资料、手术资料以及采用膀胱腹膜悬吊法的其他相关资料。结果观察组的手术时间、术中出血量、术后排气时间明显低于对照组(P<0.05)。膀胱腹膜悬吊后比悬吊前的面积增大约30%~50%,暴露深度提高约10%~20%;膀胱腹膜悬吊效果满意程度评分3.9分(总分6分);随着腹膜悬吊操作例数的增加,操作所需时间呈降低趋势。结论气腹针辅助膀胱腹膜悬吊法腹腔镜手术安全可行,能够有效地暴露手术视野,降低手术难度,便于术者操作,缩短手术时间,有利于患者快速康复,同时可在其他相关手术中灵活使用,值得在临床推广。

Objective To compare the application effect in operation and clinical efficacy of the two methods in the treatment of bladder cancer by the Laparoscopic radical cystectomy:one by using a disposable pneumoperitoneum needle combined with disposable wire tissue closure clip to suspend the bladder peritoneum(hereinafter referred to as the bladder peritoneal suspension method),and the other by conventional assistant-assisted pulling of bladder peritoneum.Methods The clinical data of 60 patients with malignant bladder tumor treated by Laparoscopic radical cystectomy from July 2016 to July 2019 in the urology department of our hospital were retrospectively analyzed.They were divided into two groups according to the different methods of operation.20 cases in the observation group were operated by bladder peritoneal suspension method;40 cases in the control group were operated by conventional assistant assisted pulling of bladder peritoneum.The general information,surgical information,and other relevant information about using bladder peritoneal suspension method in the two groups were compared.Results The average operation time,the average blood loss,and the postoperative exhaust time in the observation group were significantly shorter than those in the control group(P<0.05).Compared with the area before bladder peritoneal suspension,the area after suspension increased by 30%~50%,and the exposure depth increased by 10%~20%.The satisfaction degree of the bladder peritoneal suspension is scored 3.9(total score:6 points);with the increase of the number of operation cases of peritoneal suspensio,the time required for operation showed a downward trend.Conclusion Laparoscopic radical cystectomy for bladder cancer is safe and feasible by using the method of bladder peritoneal suspension,which can effectively expose the surgical field of vision,reduce the difficulty of the operation,facilitate the operation of the operators,shorten the operation time and help patients recover quickly.Therefore,it can be used flexibly in other related operations,and is worthy of clinical promotion.