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目的:比较腹腔镜与开放性重复肾输尿管切除术的临床疗效,并总结相关手术经验。方法:回顾性分析19例(20次)行重复肾输尿管切除术患者的临床资料,其中9例(10次)行腹腔镜手术(A组),10例(10次)行开放式手术(B组)。统计两组手术时间、术中出血量、术后住院时间、术后开始下床活动时间、肠道功能恢复时间、术后止痛剂的使用量、术后随访情况,以比较两种不同手术方式的疗效差别。结果:两组术中、术后均无并发症,均痊愈出院。A组和B组平均手术时间分别为142(110～195)min、124(90～160)min(P>0.05),术中平均出血量分别为29(1 5～40)ml、23.5(20～40)ml(P>0.05),术后住院时间分别为5.4(2～10)天、8.5(7～10)天(P<0).05),术后开始下床活动平均时间分别为24.5(18～34)h、37.4(20～58)h(P<0.05),术后肠道功能恢复平均时间分别为8.9(5～10)h、1 7.1(8～21)h(P<0.01)。A组有3例患者术后需肌注止痛剂,止痛剂平均使用次数为0.5次,而B组患者术后未出现不能耐受的疼痛。术后随访5～28个月,所有患者均未出现相关并发症。结论:腹腔镜重复肾输尿管切除手术疗效与开放手术相当,但具有术后恢复快、住院时间短的优势,可安全可靠地应用于重复肾输尿管切除。
Objective: To compare the clinical efficacy of laparoscopic and open repeat nephroureterectomy and to summarize the related surgical experience. Methods: The clinical data of 19 patients (20 times) who underwent radical nephroureterectomy were retrospectively analyzed. Among them, 9 patients underwent laparoscopic surgery (group A) and 10 patients underwent open surgery group). The operation time, intraoperative blood loss, postoperative hospital stay, postoperative ambulation time, intestinal function recovery time, postoperative analgesic dosage and postoperative follow-up were compared between the two groups The difference in efficacy. Results: There were no complications in both groups during operation and after operation, all were cured and discharged. The mean operative time in group A and group B was 142 (110-195) min and 124 (90-160) min (P> 0.05), respectively. The mean intraoperative blood loss was 29 (15-40) ml and 23.5 ~ 40) ml (P> 0.05). The postoperative hospital stay was 5.4 (2-10) days and 8.5 (7-10) days, respectively (P <0.05). The mean time of functional recovery after operation was 8.9 (5 ~ 10) h and 7.11 (8 ~ 21 h) respectively (P < 0.01). Three patients in group A required intramuscular analgesia after operation, the average number of analgesics used was 0.5, whereas patients in group B did not develop intolerable pain after operation. All the patients were followed up for 5 to 28 months without any complications. Conclusions: Laparoscopic resection of nephroureterectomy is equivalent to open surgery, but has the advantages of quick recovery and short hospital stay, which can safely and reliably be used in repeated nephroureterectomy.