本文選題：中央型腎腫瘤　切入點：后腹腔鏡下腎部分切除術　出處：《山東大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的目前外周型腎腫瘤采用腹腔鏡下腎部分切除術治療已經在臨床廣泛地開展,而中央型腎腫瘤由于位置深并且靠近腎蒂血管和集合系統(tǒng),手術難度相對較大,對腹腔鏡腎部分切除技術要求高,在現階段仍是一項充滿技術挑戰(zhàn)性的手術。經后腹腔途徑的腹腔鏡腎部分切除術在手術持續(xù)時間、手術出血量和手術并發(fā)癥方面有較大的優(yōu)勢,因此我們分析后腹腔鏡下腎部分切除術治療中央型腎腫瘤的安全性和可行性。資料與方法我們收集了 2014年12月到2016年6月期間在山東大學齊魯醫(yī)院泌尿外科行后腹腔鏡下腎部分切除術的患者資料。將61例按標準納入研究對象,其中中央型腎腫瘤患者10例,外周型腎腫瘤患者51例。對比研究采集的信息:患者性別、年齡、體重指數、ASA分級、熱缺血時間、手術時間、術中出血量、腫瘤位置、腫瘤病理直徑、腫瘤病理類型、腫瘤的Fuhrman分級、圍手術期并發(fā)癥、術前血清肌酐、術后血清肌酐、腎小球濾過率下降等,并通過問卷評分的方式評估了手術醫(yī)師工作負荷、技術操作難度、表現滿意度、時間壓力以及配合手術護理人員的工作負荷等各指標。采用SPSS 22.0統(tǒng)計軟件對數據進行統(tǒng)計分析。使用Kolmogorov-Smirnov方法檢驗計量數據的正態(tài)性,如果計量數據呈現正態(tài)分布趨勢,則使用獨立樣本t檢驗。有序變量或者不符合正態(tài)分布的數據,采用Mann-Whitney U秩和檢驗,無序分類變量使用卡方檢驗或者Fisher確切概率法檢驗,以P0.05為差異有統(tǒng)計學意義。結果兩組患者的年齡、體重指數、性別等術前資料均無差異統(tǒng)計學意義。61例手術均在全麻下順利完成,術中沒有手術方式的轉換。中央型腎腫瘤組的平均手術時間175.0±23.2min,熱缺血時間25.8±3.0min,失血量97.9±22.8ml;術后并發(fā)癥ClavienⅠ級2例,腎小球濾過率下降百分數為9.5±7.1%。外周型腎腫瘤組的平均手術時間139.7±30.6min,熱缺血時間19.1±3.9min,失血量91.6±66.1ml,術后并發(fā)癥ClavienⅠ級9例、Ⅱ級2例,腎小球濾過率下降百分數為5.9±11.2%。兩組在手術時間和手術熱缺血時間比較有差異統(tǒng)計學意義,中央型腎腫瘤組的手術時間和熱缺血時間均顯著長于外周型腎腫瘤組。在手術中失血量、腫瘤最大直徑、術后腫瘤病理類型、腫瘤Furman分級、術后并發(fā)癥、腎小球濾過率下降上比較均無差異統(tǒng)計學意義。對手術者而言,中央型腎腫瘤組的工作負荷要明顯高于外周型腎腫瘤組(3.10±0.74 vs.2.12±0.79),中央型腎腫瘤組的技術操作難度要明顯高于外周型腎腫瘤組(3.10±0.57 vs.2.37±0.75);而在表現滿意度和時間壓力上兩組之間均無明顯差異。對護理人員而言,兩組在工作負荷上無顯著差異。結論我們認為后腹腔下腎部分切除術治療中央型腎腫瘤是一種安全有效的手術方式,值得在臨床上推廣應用。
[Abstract]:Objective Laparoscopic partial nephrectomy has been widely used in the treatment of peripheral renal neoplasms, while central renal tumor is difficult because of its deep location and close to the renal pedicle vessels and collecting system. Laparoscopic partial nephrectomy is a technically challenging procedure at this stage. Laparoscopic partial nephrectomy via retroperitoneal approach lasts for a long time. The amount of blood lost and the complications of the operation have great advantages. Therefore, we analyzed the safety and feasibility of retroperitoneal laparoscopic partial nephrectomy in the treatment of central renal neoplasms. Data and methods We collected the urological department of Qilu Hospital, Shandong University from December 2014 to June 2016. Data of patients undergoing retroperitoneal laparoscopic partial nephrectomy. 61 patients were included in the study according to the criteria. There were 10 patients with central renal tumor and 51 patients with peripheral renal tumor. The information collected from the comparative study was as follows: gender, age, body mass index (BMI) ASA grade, warm ischemia time, operative time, intraoperative bleeding volume, tumor location. Tumor pathological diameter, tumor pathological type, tumor Fuhrman grade, perioperative complications, preoperative serum creatinine, postoperative serum creatinine, decreased glomerular filtration rate, etc. The technical operation difficulty, performance satisfaction, time pressure and workload of nursing staff were analyzed with SPSS 22.0 software. Kolmogorov-Smirnov method was used to test the normality of measurement data. If the measurement data show a trend of normal distribution, then the independent sample t test is used. The ordered variables or data that do not conform to the normal distribution are tested by Mann-Whitney U rank sum test, the unordered classification variables are tested by chi-square test or Fisher exact probability test. Results there was no significant difference in age, body mass index, sex and other preoperative data between the two groups. 61 cases of operation were successfully completed under general anesthesia. There was no change of operative mode during the operation. The mean operative time, hot ischemia time and blood loss were 175.0 鹵23.2min, 25.8 鹵3.0min, 97.9 鹵22.8 ml, respectively, and the postoperative complications were Clavien 鈪，

本文編號：1629351