摘要
目的探讨蛇骨肝牵开器在机器人右侧肾上极、肾上腺手术中的应用效果。方法设计蛇骨肝牵开器,选取2017年9月~2019年1月择期36例右侧机器人辅助腹腔镜肾部分切除(robot-assisted laparoscopic partial nephrectomy,RPN)、9例右侧机器人辅助腹腔镜肾上腺切除术(robot-assisted laparoscopic adrenalectomy,RALA)为观察组,使用蛇骨肝牵开器协助暴露术野;2016年3月~2017年8月择期36例右侧RPN、9例右侧RALA为对照组,助手使用腔镜抓钳协助暴露术野。比较术者对术野暴露满意度、助手操作舒适度、手术时间、出血量及肾部分切除术中肾热缺血时间。结果术者对术野暴露满意度及助手操作舒适度观察组均优于对照组(术野暴露满意、较满意、不满意观察组分别为34、9、2例,对照组为4、11、30例,Z=-6.917,P=0.000;助手操作舒适、较舒适、不舒适观察组为33、10、2例,对照组为3、8、34例,Z=-7.266,P=0.000)。观察组手术时间、出血量、RPN肾热缺血时间均明显少于对照组(P<0.05)。结论在机器人辅助腹腔镜右侧肾上极、肾上腺手术中应用蛇骨肝牵开器能提高术野暴露满意度及操作舒适度,减少手术时间、术中出血量,并缩短右侧肾部分切除术中肾脏热缺血时间。
Objective To investigate the effect of the application of a self-made liver retractor in robot-assisted surgery of right kidney and adrenal gland.Methods A total of 36 cases of right partial nephrectomy and 9 cases of right adrenalectomy of robot-assisted laparoscopy from September 2017 to January 2019 were selected as the observation group,and a self-made liver retractor was used to help expose the surgical field during the operation.Another 36 cases of right partial nephrectomy(upper pole)and 9 cases of right adrenalectomy of robot-assisted laparoscopy from March 2016 to August 2017 were selected as the control group,and the endoscopic grappling forceps were used to expose the surgical field.The satisfaction degree of the operators,the comfort degree of the assistants,the operation time,the amount of bleeding and the warm ischemia time of partial nephrectomy were evaluated.ResultsThe satisfaction degree of the operator with surgical field exposure and the comfort degree of the assistant in the observation group were better than those in the control group(there were 34,9,2 cases in the observation group for satisfied,fair satisfied and dissatisfied feedback respectively,and 4,11,30 cases in the control group,Z=-6.917,P=0.000;there were 33,10,2 cases in the observation group for comfortable,fair comfortable and discomfort feedback,and 3,8,34 cases in the control group,Z=-7.266,P=0.000).The operation time,amount of bleeding and the time of renal warm ischemia in the observation group were significantly shorter than those in the control group(P<0.05).Conclusion The application of self-made liver retractor in right kidney and adrenalectomy of robot-assisted laparoscopicopy can improve the satisfaction of operators and the comfort of assistants,reduce the operation time and blood loss,and also reduce the warm ischemic time of kidney.
作者
喻晓芬
陈肖敏
Yu Xiaofen;Chen Xiaomin(Operation Room, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, China)
出处
《中国微创外科杂志》
CSCD
北大核心
2020年第6期530-533,共4页
Chinese Journal of Minimally Invasive Surgery
基金
浙江省医药卫生科技计划项目(2018KY212)。
