肾蒂血管处理新策略对缩短后腹腔镜下肾癌根治术学习曲线的正面作用

doi:10.3877/cma.j.issn.1674-3253.2022.02.012

中华腔镜泌尿外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (02) : 147 -150. doi: 10.3877/cma.j.issn.1674-3253.2022.02.012

临床研究

肾蒂血管处理新策略对缩短后腹腔镜下肾癌根治术学习曲线的正面作用

刘和谦¹, 陶凌松¹^,^†(

), 王家伟¹, 陈弋生¹, 邹滨¹, 沈旭东¹

^1. 241000　安徽，芜湖市第二人民医院泌尿外科

收稿日期:2020-12-25 出版日期:2022-04-01
通信作者: 陶凌松

Positive impact of new treatment strategy of renal pedicle on shortening the learning curve of retroperitoneoscopic radical nephrectomy

Heqian Liu¹, Lingsong Tao¹^,^†(), Jiawei Wang¹, Yisheng Chen¹, Bin Zou¹, Xudong Shen¹

^1. Department of Urology, the Second People’s Hospital of Wuhu, Anhui 241000, China

Received:2020-12-25 Published:2022-04-01
Corresponding author: Lingsong Tao

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目的

探讨肾蒂血管处理新策略对缩短后腹腔镜下肾癌根治术学习曲线的正面作用。

方法

分析我院2018年1月至2020年4月我科初学者在后腹腔镜下肾癌根治术中采用肾蒂血管处理新技巧治疗40例肾癌患者的临床资料。主要观察移交高年资技术熟练的主任医师的例数、手术时间与手术例数的关系及并发症发生情况，并评估初学者的学习曲线。

结果

学习曲线中的40例手术均顺利完成，无中转开放病例。有3例术中交由主任医师完成，均见于前8例患者，1例因未寻及肾动脉，1例因血管损伤，1例因周围明显粘连。2例术后出现高热。所有手术平均时间（150±45）min，术后血红蛋白下降（13.7±12.3）g/L，术后白蛋白下降（6.0±3.5）g/L。随着手术例数及手术经验的累加，手术时间整体呈下降趋势，16例后手术时间进入稳定期。术中术后均未出现Clavien分级Ⅲ级及以上并发症。

结论

学习曲线内的术者采用肾蒂血管处理新技巧可很快独立完成后腹腔镜下肾癌根治术，无明显并发症发生，16例后技术成熟并进入稳定期。

关键词: 腹腔镜, 肾癌, 肾蒂血管, 学习曲线

Objective

To explore the learning curve of using new treatment strategy of renal pedicle in retroperitoneoscopic radical nephrectomy.

Methods

The clinical data of 40 cases of renal carcinoma treated by new treatment strategy of pedicle vessels during retroperitoneoscopic radical nephrectomy for beginners from Jan. 2018 to Apr.2020 were analyzed. The contents of observation included the number of transferation rate to skilled director, the correlation between the operation time and number of cases, and the incidence of complications.

Results

All operations were successfully completed, with no conversion to open surgery. 3 cases were transfered to skilled director, all of which were found in the first 8 patients, renal artery was not found in 1 case, renal vessel was damaged in 1 case, and perirenal adhesion was observed in 1 case. After the beginners undertook 16 cases, they could perform the procedures stably without any serious complications.

Conclusion

New surgeons in the learning curve could independently complete retroperitoneoscopic radical nephrectomy by the new pedicled vascular treatment strategy, without obvious complications. After 16 cases, the technique was mature and stable.

Key words: Laparoscope, Renal carcinoma, Renal pedicle vascular, Learning curve

图1 一名主治医师行后腹腔镜肾癌根治术的学习曲线

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