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目的:分析泌尿外科耻骨上辅助经脐单孔腹腔镜手术(SA-LESS)并发症,探讨其防治措施。方法:回顾性分析2010年7月~2015年4月施行的573例SA-LESS手术病例资料,其中男356例,女217例,平均年龄45.4(6~78)岁,平均身体质量指数23.6(15.3~32.8)kg/m~2。包括单纯性肾切除术150例、根治性肾切除术64例、肾部分切除术16例、重复肾切除术15例、上尿路全切除术29例、肾上腺或肾上腺肿瘤切除术43例、肾囊肿去顶术34例、肾盂或输尿管切开取石术183例、肾盂成形术15例、输尿管膀胱再植术24例。分别采用Satava和Clavien-Dindo分级系统评估术中和术后并发症,并重点分析严重并发症及其处理。结果:本组术中、术后共发生并发症65例(11.34%),其中严重并发症21例(3.66%)。术中严重并发症12例,包括下腔静脉损伤3例、肾静脉损伤3例、髂静脉损伤1例、胸膜损伤1例、十二指肠损伤1例、回肠损伤1例、脾脏损伤1例、股神经损伤1例;术后严重并发症9例,包括继发性出血5例、术后尿漏3例、肾盂成形术后再次狭窄1例。所有并发症均得到妥善处置,转归良好。无术中及术后死亡病例。结论:SA-LESS安全可行,但存在一定的严重并发症,应采取相应措施积极防治。
Objective: To analyze the complications of suprapubic assisted laparoscopic transabdominal surgery (SA-LESS) in urology and to explore its prevention and treatment. Methods: The data of 573 SA-LESS cases from July 2010 to April 2015 were retrospectively analyzed. There were 356 males and 217 females, with an average age of 45.4 (range, 6 to 78) years and an average body mass index of 23.6 ( 15.3 ~ 32.8) kg / m ~ 2. Including simple nephrectomy in 150 cases, radical nephrectomy in 64 cases, partial nephrectomy in 16 cases, repeated nephrectomy in 15 cases, upper urinary total resection in 29 cases, adrenalectomy or adrenalectomy in 43 cases, kidney 34 cases of cyst debridement, 183 cases of renal pelvis or ureterolithotomy, 15 cases of pyeloplasty and 24 cases of ureteric bladder replantation. The Satava and Clavien-Dindo grading systems were used to assess intraoperative and postoperative complications, with emphasis on the analysis of serious complications and their management. Results: There were 65 cases (11.34%) of complications occurred in this group and 21 cases (3.66%) were serious complications. Intraoperative serious complications in 12 cases, including 3 cases of inferior vena cava lesions, renal vein injury in 3 cases, iliac vein injury in 1 case, pleural injury in 1 case, duodenal injury in 1 case, ileal injury in 1 case, spleen injury in 1 case , 1 case of femoral nerve injury; 9 cases of serious postoperative complications, including 5 cases of secondary bleeding, 3 cases of postoperative urinary leakage, stenosis again in 1 case after pyeloplasty. All complications have been properly disposed of, a good return. No intraoperative and postoperative deaths. Conclusion: SA-LESS is safe and feasible, but there are some serious complications, and should take appropriate measures to prevent and treat it.