中国泌尿外科医师腹腔镜肾切除术完整标本取出的切口位置选择现状调查

Current situation of incision sites in laparoscopic nephrectomy for intact specimens by urologists in China

目的了解目前国内泌尿外科医师腹腔镜肾切除术完整标本取出切口位置选择的现状,为规范完整标本取出切口位置选择提供依据。方法2021年6月20日—2021年7月4日,对自媒体泌尿外科学习联盟微信群的2万余名泌尿外科医师进行问卷调查,统计分析参与医师的一般资料、选择的切口位置及相关并发症。结果收回有效问卷601份,覆盖31个省、自治区、直辖市。手术入路:腹腔入路68人、后腹腔入路432人、两种入路者101人;切口位置选择:腰部横切口者97人、腰部背侧斜切口者202人、腰部腹侧斜切口者119人、腹直肌旁直切口者93人、下腹部斜切口(Gibson)者112人、下腹部正中弧形切口(Pfannenstiel)11人、下腹部正中切口者7人、上腹部正中切口者2人、腋中线直切口15人;399位医师选择切断肌肉、202位医师选择不切断肌肉。232位医师回答术后2周切口有疼痛,369位医师回答无。325位医师回答术后2周切口周围有麻木,276位医师回答无。66位医师回答术后出现了切口疝,535位医师回答没有切口疝。结论国内腹腔镜肾切除术以后腹腔镜为主,后腹腔镜肾切除术完整标本取出切口位置多选择腰部切口,经腹腹腔镜完整标本取出切口位置选择多种多样,腹腔镜肾切除术完整标本取出切口位置选择缺乏规范性。

Objective To investigate the current status of incision sites to obtain intact specimens in laparoscopic nephrectomy by urologists in China,so as to provide reference for the standardized procedure.Methods During Jun.20,2021 and Jul.4,2021,more than 20000 urologists in a WeChat group were surveyed with a questionnaire.The general data,incision sites and related complications were statistically analyzed.Results A total of 601 valid questionnaires were collected,covering urologists from 31 provinces,autonomous regions and municipalities.Surgical approaches:68 urologists chose trans-abdominal approach,432 chose posterior abdominal space approach,101 chose both surgical approaches.Incision sites:97 urologists chose lumbar transverse incision,202 chose dorsal oblique incision of the waist,119 chose ventral oblique incision,93 chose the paramedian incision,112 chose the lower abdominal oblique incision(Gibson),11 chose the transverse lower abdominal incision(Pfannenstiel),7 chose the median incision of the lower abdomen,2 chose the median incision in the upper abdomen,15 chose axillary midline direct incision;399 chose to cut off the muscles,and 202 chose not to.Complications:232 urologists reported pain after 2 weeks,369 reported no pain;325 reported numbness after 2 weeks,276 reported no numbness;66 reported incisional hernia,535 reported no hernia.Conclusions Chinese urologists tend to choose retroperitoneoscopic nephrectomy and waist incision to obtain intact specimens.Transperitoneal laparoscopic nephrectomy has a variety of incisions for intact specimens.There is no standardized incision sites to obtain intact specimens.