3D 高清腹腔镜系统在泌尿外科手术中的应用

摘要

目的：探讨3D高清腹腔镜系统在泌尿外科领域的应用价值。方法回顾性分析2014年3月～2016年9月我院应用STORZ 3D高清腹腔镜系统完成泌尿外科手术75例资料，包括后腹腔镜肾部分切除术23例、根治性肾切除术17例、肾上腺肿物切除术5例、肾囊肿去顶术1例，经腹腔途径完全腹腔镜肾输尿管全长切除术2例，经腹膜外途径腹腔镜根治性前列腺切除术19例，经腹膜途径腹腔镜根治性膀胱切除术8例（尿流改道方式为回肠膀胱术7例，Studer原位新膀胱术1例）。结果75例手术顺利进行，均获成功。肾部分切除术手术时间76～206 min，术中出血10～200 ml；根治性肾切除术手术时间84～228 min，术中出血10～400 ml；肾上腺肿物切除术手术时间63～115 min，术中出血5～150 ml；肾囊肿去顶术手术时间53 min，术中出血20 ml；肾输尿管全长切除术手术时间分别为393 min和165 min，术中出血分别为300 ml和50 ml；根治性前列腺切除术手术时间121～410 min，术中出血20～600 ml；根治性膀胱切除、回肠膀胱术手术时间220～561 min，术中出血150～600 ml；根治性膀胱切除、Studer原位新膀胱术手术时间288 min，术中出血200 ml。75例围手术期无严重（Ⅲ～Ⅳ级）并发症发生。结论3D腹腔镜有三维立体高清的画面，解剖层次清晰，缝合操作相对容易，可以在临床推广应用。%Objective To evaluate the feasibility and clinical efficacy of 3D imaging system in laparoscopic surgery in urology. Methods From March 2014 to September 2016, 75 cases of 3D laparoscopic urological surgery were completed with STORZ 3D laparoscopy system , including 23 cases of partial nephrectomy , 17 cases of radical nephrectomy , 5 cases of adrenal tumor resection, 1 case of renal cyst decortication , 2 cases of nephroureterectomy , 19 cases of radical prostatectomy , and 8 cases of total cystectomy.Urinary diversion was performed with the Bricker operation in 7 patients and with orthotopic neobladder in 1 patient. Results All the 75 surgeries were completed successfully .The surgery time of partial nephrectomy was 76-206 min,with a blood loss of 10-200 ml.The surgery time of radical nephrectomy was 84-228 min, with a blood loss of 10-400 ml.The surgery time of adrenal tumor resection was 63-115 min, with a blood loss of 5-150 ml.The surgery time of renal cyst decortication was 53 min, with a blood loss of 20 ml.The surgery time of nephroureterectomy was 393 min and 165 min,with a blood loss of 300 ml and 50 ml. The surgery time of radical prostatectomy was 121-410 min, with a blood loss of 20-600 ml.The surgery time of total cystectomy with Bricker operation was 220 -561 min, with a blood loss of 150 -600 ml.The surgery time of total cystectomy with orthotopic neobladder was 288 min, with a blood loss of 200 ml.No severe complications ( classⅢ-Ⅳ) occurred during perioperative period in the 75 patients. Conclusions 3D imaging system can provide anatomical layer vision similar to open surgery .It is feasible and safe, and can be used in urological surgery .