CAJ | 학술논문

目的：探讨不使用“蓝蝶”装置行手助腹腔镜肾部分切除术治疗T1 b期肾肿瘤的方法及临床效果。方法2011年2月—2013年2月住院的T1b期肾癌15例,在不使用“蓝蝶”装置的情况下,行手助腹腔镜肾部分切除术,根据术者手掌直径做皮肤切口,在手进入后腹腔后辅助操作,用布巾钳钳夹切口两侧防止漏气。结果所有手术均顺利完成,平均手术时间(120.5±25.6)min,术中平均热缺血时间(25.2±7.4)min,术中平均出血量(48.3±10.2)ml,平均手术切口长度(6.5±0.6)cm,术后平均住院时间(9.2±2.4)d；术后尿漏1例,予输尿管支架管治疗后痊愈,围术期无严重并发症。术后平均随访(16.4±11.2)个月,所有患者肾功能均正常且未见肿瘤复发及转移。结论不使用“蓝蝶”装置行手助腹腔镜肾部分切除术治疗T1 b期肾肿瘤安全、有效,学习曲线短,但远期疗效尚需大样本对照研究和长期随访观察。
목적：탐토불사용“람접”장치행수조복강경신부분절제술치료T1 b기신종류적방법급림상효과。방법2011년2월—2013년2월주원적T1b기신암15례,재불사용“람접”장치적정황하,행수조복강경신부분절제술,근거술자수장직경주피부절구,재수진입후복강후보조조작,용포건겸겸협절구량측방지루기。결과소유수술균순리완성,평균수술시간(120.5±25.6)min,술중평균열결혈시간(25.2±7.4)min,술중평균출혈량(48.3±10.2)ml,평균수술절구장도(6.5±0.6)cm,술후평균주원시간(9.2±2.4)d；술후뇨루1례,여수뇨관지가관치료후전유,위술기무엄중병발증。술후평균수방(16.4±11.2)개월,소유환자신공능균정상차미견종류복발급전이。결론불사용“람접”장치행수조복강경신부분절제술치료T1 b기신종류안전、유효,학습곡선단,단원기료효상수대양본대조연구화장기수방관찰。
Objective To investigate operational methods and clinical effect of hand-assisted laparoscopic without"Lapdisc" partial nephrectomy for treatment of T1b renal cell carcinoma. Methods 15 patients with T1b renal cell carcinoma admitted during Feb 2011 and Feb 2013 were retrospectively analyzed, according to the diameter of the palm for skin incision, after the hand was put into abdominal cavity for auxiliary operations and towel forceps clamps were used to prevent leakage, and hand assisted laparoscopic partial nephrectomy without"Lapdisc" was performed. Results All the 15 cases were operated upon successfully without conversion to open surgery, and there were no severe complications in the perioperative period. The mean operation time was (120. 5 ± 25. 6)min, mean warm ischemia time was (25. 2 ± 7. 4)min, the average amount of bleeding during operation was (48. 3 ± 10. 2) ml, mean incision length was (6. 5 ± 0. 6) cm and mean postoperative hospital stay was (9. 2 ± 2. 4)d. Postoperative urinary leakage was found in one case and was successfully treated with placement of a double J tube. All the patients had normal renal function and had no tumor recurrence or metastasis during a mean follow-up of ( 16. 4 ± 11. 2)months. Conclusion Hand assisted laparoscopic partial nephrectomy without "Lapdisc" is safe and effective for treat-ment of patients with T1b renal cell carcinoma. But the long-term effect still needs more sample research and a long-term follow-up study.