中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2012年
10期
729-734
,共6页
单孔腹腔镜手术%微创外科手术%泌尿外科手术
單孔腹腔鏡手術%微創外科手術%泌尿外科手術
단공복강경수술%미창외과수술%비뇨외과수술
Laparoendoscopic single-site surgery,LESS%Minimally invasive surgery%Urologic surgery
目的 系统回顾并总结评价单孔腹腔镜技术在中国泌尿外科领域的发展现状. 方法 通过检索2009年1月至2012年7月万方数据资源系统、中国知网CNKI、维普期刊、中国生物医学文献数据库、GoogleScholar搜索引擎、MEDLINE等数据库中我国学者公开发表的有关泌尿外科单孔腹腔镜手术文献,分析泌尿外科单孔腹腔镜技术在国内的临床应用特点和变化趋势. 结果 共纳入全国 66家单位205篇相关文献,其中科学引文索引(science citation index,SCI)期刊收录文献26篇,中文期刊文献179篇.文献类型构成为:病例报告或经验介绍133篇(64.9％),对比研究13篇(6.3％),综述、述评20篇(9.8％),护理相关28篇(13.7％),动物实验6篇(2.9％),培训相关5篇(2.4％).共报道临床病例1790例,其中上尿路手术1018例(56.9％),下尿路手术104例(5.8％),男科及其他手术668例(37.3％).肿瘤相关手术336例(18.8％),需重建的手术334例(18.7％).按手术通道分为单孔多通道手术1043例(58.3％),单切口多套管手术747例(41.7％).单孔多通道手术中选择商业化专用装置者476例(45.6％),选择自制装置者567例(54.4％).按入路途径分为经腹腔途径1065例(59.5％),经腹膜外(腹膜后和腹膜前)途径725例(40.5％);按切口部位分为经脐单一切口1047例(58.5％),经脐外单一切口743例(41.5％).共涉及25种手术方式:①上尿路手术,包括肾上腺切除、肾囊肿去顶减压、单纯性肾切除(无功能肾、重复肾等)、肾癌根治性切除、肾脏部分切除、肾肿瘤冷冻消融、活体供肾切取、肾蒂周围淋巴管结扎、肾盂或输尿管癌根治、肾盂或输尿管上段结石切开取石、肾盂输尿管狭窄成型、输尿管松解等手术;②下尿路手术,包括膀胱癌根治性切除+尿流改道、膀胱癌膀胱部分切除、经膀胱膀胱肿瘤剜除、输尿管膀胱再植、前列腺癌根治(经腹腔、经腹膜外、经膀胱)、经膀胱前列腺剜除、盆腔淋巴结清扫等手术;③男科手术,包括精索静脉曲张结扎、隐睾下降固定、男性假两性畸形整形、小儿鞘状突未闭修复等手术;④其他手术,包括腹膜透析管放置、腹膜后淋巴结清扫术.单一术式病例数前三位的依次为:精索静脉曲张结扎术601例(33.6％)、肾囊肿去顶减压术408例(22.8％)、肾上腺切除术179例(10.0％).总体手术中转率为5.5％,总体手术并发症发生率为3.4％. 结论 泌尿外科单孔多通道腹腔镜技术在国内已广泛普及,开展术式几乎涵盖了所有传统腹腔镜手术类型,但目前仍以非重建手术治疗泌尿系良性病变为主要适应证.总体上说,单孔腹腔镜技术在国内泌尿外科领域的应用仍处于初级探索阶段,需要更多的自主创新和规范科研工作,以更好地评价单孔腹腔镜技术在泌尿外科手术中的应用价值.
目的 繫統迴顧併總結評價單孔腹腔鏡技術在中國泌尿外科領域的髮展現狀. 方法 通過檢索2009年1月至2012年7月萬方數據資源繫統、中國知網CNKI、維普期刊、中國生物醫學文獻數據庫、GoogleScholar搜索引擎、MEDLINE等數據庫中我國學者公開髮錶的有關泌尿外科單孔腹腔鏡手術文獻,分析泌尿外科單孔腹腔鏡技術在國內的臨床應用特點和變化趨勢. 結果 共納入全國 66傢單位205篇相關文獻,其中科學引文索引(science citation index,SCI)期刊收錄文獻26篇,中文期刊文獻179篇.文獻類型構成為:病例報告或經驗介紹133篇(64.9％),對比研究13篇(6.3％),綜述、述評20篇(9.8％),護理相關28篇(13.7％),動物實驗6篇(2.9％),培訓相關5篇(2.4％).共報道臨床病例1790例,其中上尿路手術1018例(56.9％),下尿路手術104例(5.8％),男科及其他手術668例(37.3％).腫瘤相關手術336例(18.8％),需重建的手術334例(18.7％).按手術通道分為單孔多通道手術1043例(58.3％),單切口多套管手術747例(41.7％).單孔多通道手術中選擇商業化專用裝置者476例(45.6％),選擇自製裝置者567例(54.4％).按入路途徑分為經腹腔途徑1065例(59.5％),經腹膜外(腹膜後和腹膜前)途徑725例(40.5％);按切口部位分為經臍單一切口1047例(58.5％),經臍外單一切口743例(41.5％).共涉及25種手術方式:①上尿路手術,包括腎上腺切除、腎囊腫去頂減壓、單純性腎切除(無功能腎、重複腎等)、腎癌根治性切除、腎髒部分切除、腎腫瘤冷凍消融、活體供腎切取、腎蒂週圍淋巴管結扎、腎盂或輸尿管癌根治、腎盂或輸尿管上段結石切開取石、腎盂輸尿管狹窄成型、輸尿管鬆解等手術;②下尿路手術,包括膀胱癌根治性切除+尿流改道、膀胱癌膀胱部分切除、經膀胱膀胱腫瘤剜除、輸尿管膀胱再植、前列腺癌根治(經腹腔、經腹膜外、經膀胱)、經膀胱前列腺剜除、盆腔淋巴結清掃等手術;③男科手術,包括精索靜脈麯張結扎、隱睪下降固定、男性假兩性畸形整形、小兒鞘狀突未閉脩複等手術;④其他手術,包括腹膜透析管放置、腹膜後淋巴結清掃術.單一術式病例數前三位的依次為:精索靜脈麯張結扎術601例(33.6％)、腎囊腫去頂減壓術408例(22.8％)、腎上腺切除術179例(10.0％).總體手術中轉率為5.5％,總體手術併髮癥髮生率為3.4％. 結論 泌尿外科單孔多通道腹腔鏡技術在國內已廣汎普及,開展術式幾乎涵蓋瞭所有傳統腹腔鏡手術類型,但目前仍以非重建手術治療泌尿繫良性病變為主要適應證.總體上說,單孔腹腔鏡技術在國內泌尿外科領域的應用仍處于初級探索階段,需要更多的自主創新和規範科研工作,以更好地評價單孔腹腔鏡技術在泌尿外科手術中的應用價值.
목적 계통회고병총결평개단공복강경기술재중국비뇨외과영역적발전현상. 방법 통과검색2009년1월지2012년7월만방수거자원계통、중국지망CNKI、유보기간、중국생물의학문헌수거고、GoogleScholar수색인경、MEDLINE등수거고중아국학자공개발표적유관비뇨외과단공복강경수술문헌,분석비뇨외과단공복강경기술재국내적림상응용특점화변화추세. 결과 공납입전국 66가단위205편상관문헌,기중과학인문색인(science citation index,SCI)기간수록문헌26편,중문기간문헌179편.문헌류형구성위:병례보고혹경험개소133편(64.9％),대비연구13편(6.3％),종술、술평20편(9.8％),호리상관28편(13.7％),동물실험6편(2.9％),배훈상관5편(2.4％).공보도림상병례1790례,기중상뇨로수술1018례(56.9％),하뇨로수술104례(5.8％),남과급기타수술668례(37.3％).종류상관수술336례(18.8％),수중건적수술334례(18.7％).안수술통도분위단공다통도수술1043례(58.3％),단절구다투관수술747례(41.7％).단공다통도수술중선택상업화전용장치자476례(45.6％),선택자제장치자567례(54.4％).안입로도경분위경복강도경1065례(59.5％),경복막외(복막후화복막전)도경725례(40.5％);안절구부위분위경제단일절구1047례(58.5％),경제외단일절구743례(41.5％).공섭급25충수술방식:①상뇨로수술,포괄신상선절제、신낭종거정감압、단순성신절제(무공능신、중복신등)、신암근치성절제、신장부분절제、신종류냉동소융、활체공신절취、신체주위림파관결찰、신우혹수뇨관암근치、신우혹수뇨관상단결석절개취석、신우수뇨관협착성형、수뇨관송해등수술;②하뇨로수술,포괄방광암근치성절제+뇨류개도、방광암방광부분절제、경방광방광종류완제、수뇨관방광재식、전렬선암근치(경복강、경복막외、경방광)、경방광전렬선완제、분강림파결청소등수술;③남과수술,포괄정색정맥곡장결찰、은고하강고정、남성가량성기형정형、소인초상돌미폐수복등수술;④기타수술,포괄복막투석관방치、복막후림파결청소술.단일술식병례수전삼위적의차위:정색정맥곡장결찰술601례(33.6％)、신낭종거정감압술408례(22.8％)、신상선절제술179례(10.0％).총체수술중전솔위5.5％,총체수술병발증발생솔위3.4％. 결론 비뇨외과단공다통도복강경기술재국내이엄범보급,개전술식궤호함개료소유전통복강경수술류형,단목전잉이비중건수술치료비뇨계량성병변위주요괄응증.총체상설,단공복강경기술재국내비뇨외과영역적응용잉처우초급탐색계단,수요경다적자주창신화규범과연공작,이경호지평개단공복강경기술재비뇨외과수술중적응용개치.
Objective To evaluate the status of urological laparoendoscopic single-site surgery (LESS) technique in China. Methods We had conducted a systematic review of literatures of urological laparoendoscopic single-site surgery published from Chinese institutions using WanFang,CNKI,VIP,CBM,GoogleScholar and MEDLINE databases.All relevant articles were selected with consensus and analyzed according to the inclusion and exclusion criteria. Results Overall,205 articles from 66 different centers all over China published between January 2009 and June 2012 were included in the analysis. Of which,there were 26 articles of science citation index papers and 179 articles from Chinese academic journals.The included literature was mainly composed of case series reports ( 133 articles,64.9％ ),comparison studies (13 articles,6.3％ ),reviews or comments (20 papers,9.8％ ),nursing related papers (28 pieces,13.7％ ),animal surgery studies (6 articles,2.9％ ),and training (5 articles,2.4％ ).A total of 1790 clinical cases were reported during the study period,56.9％ of these were procedures done in the upper urinary tract,only 5.8％ were in the lower urinary tract,and 37.3％ were genital or other procedures.Procedures of tumor-related and reconstruction required accounted for 18.8％ and 18.7％,respectively.Pure single-port technique was applied on 58.3％ of cases.In cases of a single-port platform used,45.6％ used the commercially available devices and 54.4％ used homemade devices.Transperitoneal accesses were adopted in 59.5％ of cases and the other 40.5％ were performed through extraperitoneal approaches.The umbilicus was used as the site of access in 58.5％ of cases.A total of 25 indications were reported,including adrenalectomy,nephrectomy and ureterolithotomy,etc. in the upper urinary tract,radical cystectomy,radical prostatectomy and transvesical enucleation of the prostate,etc.in the lower urinary tract,and varicocelectomy,orchidopexy and others. The three most often done procedures were varicocelectomy (601 cases,33.6％ ),renal cyst decortication (408 cases,22.8％ ) and adrenalectomy ( 179 cases,10.0％ ).The overall conversion rate was 5.5％,and complications were encountered in 3.4％ of cases. Conclusions Laparoendoscopic single-site surgery has been widely adopted by Chinese urologists and largely covered the spectrum of conventional urologic laparoscopic procedures,with most of these being non-reconstructive operations for the treatment of benign diseases.In large,we are still under the initial stage of LESS application in urology.And more work on creative innovation and well-designed studies are needed to further evaluate its role in the urological minimally invasive surgery.
