摘要
目的探讨机器人辅助腹腔镜肾盂成型术联合加速康复治疗肾盂输尿管连接部梗阻的可行性和有效性,观察临床疗效。方法回顾性分析2014年11月至2019年12月东部战区总医院泌尿外科收治的的肾盂输尿管连接部梗阻48例患者的临床资料,所有患者均接受机器人辅助腹腔镜肾盂成型术。2017年11月前的26例患者围术期按传统方法治疗(传统组,n=26)。2017年12月及以后的患者围术期采用加速康复外科(ERAS)策略(ERAS组n=22)。对比分析2组患者临床资料、围术期指标、术后随访结果。结果ERAS组和传统组患者手术时间[(100.23±21.18)min vs(109.39±22.97)min]、术中失血量[(21.13±8.29)mL vs(20.09±7.40)mL]、入院C反应蛋白[(0.91±1.59)mg/L vs(0.59±0.23)mg/L]、血白细胞计数[(5.66±0.91)×10^9/L vs(6.16±1.22)×10^9/L]、术后24 h疼痛评分(0.79±0.22 vs 0.84±0.22)、术后复查肾盂分离程度比较差异无统计学意义(P>0.05)。术后48 h疼痛评分(0.80±0.26 vs 1.42±0.20)、术后72 h疼痛评分(0.84±0.24 vs 1.81±0.37)、术后C反应蛋白[(22.72±7.05)mg/L vs(40.24±13.91)mg/L]、术后血白细胞[(8.45±1.06)×10^9/L vs(11.14±1.34)×10^9/L]、肠道功能恢复时间[(46.31±8.59)h vs(59.47±16.20)h]、术后住院时间[(4.86±1.69)d vs(6.79±2.37)d]、腹腔引流管移除时间[(2.18±1.09)d vs(8.04±1.34)d]、双J管移除时间[(20.77±4.74)d vs(75.28±15.55)d)]、围术期并发症发生率(4.5%vs 15.3%)、双J管相关并发症发生率(18.0%vs 34.6%)差异有统计学意义(P<0.05)。结论优化的ERAS策略结合达芬奇手术机器人治疗肾盂输尿管连接部梗阻是安全有效的围术期处理策略,值得在临床推广。
Objective To observe the feasibility and effectiveness of robot-assisted laparoscopic pyeloplasty combined with accelerated rehabilitation in the treatment of ureteropelvic junction obstruction.Methods Forty-eight patients with ureteropelvic junction obstruction admitted to the Department of Urology of the Eastern Theater General Hospital of the Chinese people's Liberation Army from November 2014 to December 2019 were retrospectively analyzed.All patients received robot-assisted laparoscopic pyeloplasty.The patients before November 2017 were treated according to the traditional method during the perioperative period,which was the traditional group(n=26).Patients in December 2017 and beyond were divided into accelerated rehabilitation(enhanced recovery after surgery,ERAS)group(n=22)and ERAS strategy was used in perioperative period.The clinical data,perioperative parameters and postoperative follow-up results of two groups were compared and analyzed.Result s In ERAS group and traditional group,the operation time,intraoperative blood loss,admission C-reactive protein,white blood cell count,postoperative pain score and postoperative pain score were(100.23±21.18)min vs(109.39±22.97)min,(21.13±8.29)mL vs(20.09±7.40)mL,(0.91±1.59)mg/L vs(0.59±0.23)mg/L,(5.66±0.91)×10^9/L vs(6.16±1.22)×10^9/L,0.79±0.22 vs 0.84±0.22,respectively.There was no significant difference in the degree of renal pelvis separation after operation(P>0.05).Postoperative 48 h pain score(0.80±0.26 vs 1.42±0.20),72 h pain score(0.84±0.24 vs 1.81±0.37),postoperative C-reactive protein[(22.72±7.05)mg/L vs(40.24±13.91)mg/L],postoperative WBC[(8.45±1.06)×10^9/L vs(11.14±1.34)×10^9/L],intestinal function recovery time[(46.31±8.59)h vs(59.47±16.20)h],postoperative hospital stay[(4.86±1.69)d vs(6.79±2.37)d].There were significant differences in removal time of abdominal drainage tube[(2.18±1.09)d vs(8.04±1.34)d],removal time of double J tube[(20.77±4.74)d vs(75.28±15.55)d)],incidence of perioperative complications(4.5%vs 15.3%)and incidence of complications related to double J tube(18.0%vs 34.6%).Conclusion The optimized ERAS strategy combined with Leonardo da Vinci surgical robot in the treatment of ureteropelvic junction obstruction is a safe and effective perioperative management strategy,which is worth popularizing in clinic.
作者
盛正成
沈天一
周昱霖
张征宇
葛京平
周文泉
SHENG Zheng-cheng;SHEN Tian-yi;ZHOU Yu-lin;ZHANG Zheng-yu;GE Jing-ping;ZHOU Wen-quan(Department of Urology,Jinling Clinical Medical College Affiliated to Nanjing Medical University/General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China)
出处
《东南国防医药》
2020年第5期497-500,共4页
Military Medical Journal of Southeast China
关键词
加速康复外科
肾盂输尿管连接部梗阻
机器人辅助腹腔镜肾盂成型术
微创手术
enhanced recovery after surgery
ureteropelvic junction obstruction
robot-assisted laparoscopic pyeloplasty
minimally invasive surgery
作者简介
通信作者:周文泉,E-mail:1423594460@qq.com。
