气囊法、手指分离法及IUPU法建腔应用于泌尿外科常规后腹腔镜手术中的效果研究

摘要

Objective To compare the effect of balloon technique, finger separation technique, IUPU technique applied in establishing retroperitoneal space in urologic surgery. Methods Total of 600 patients undergoing laparoscopic surgery admitted to the Third People′s Hospital of Hubei Province from Jan. 2008 to Jan. 2015 were divided into three groups randomly,according to the different ways of establishing the retro-peritoneal space. Balloon group used balloon technique to build up the retroperitoneal space, finger group used finger separation technique, IUPU group used IUPU technique, establishing time, intra-postoperative complications and wound healing were recorded. Results The establishing time of IUPU group, balloon group,and finger group were (4. 2 ± 1. 3) min,(5. 3 ± 2. 9) min,(7. 4 ± 3. 3) min,there was statistically significant difference(P<0.05). Blood loss in each group had no significantly significant difference (P>0. 05);an air balloon bursted,one patient in balloon group was diverted into open surgery,and the retroper-itoneal space was constructed successfully for all the other patients. There were no serious post-operative com-plications in three groups. wound healing in each group was in good condition. Conclusion All of the three techniques can be used for establishing retroperitoneal space:the balloon technique needs longer time,and it has the risk of waist bulging and balloon burst;IUPU technique is time-saving, convenient, easy and with smaller incision,the finger technique performance is between them. IUPU technique is more simple and time saving to expand retroperitoneal space,thus is worth being promoted in clinical.%目的：探讨气囊法、手指分离法及IUPU法建腔应用于泌尿外科常规后腹腔镜手术中的效果。方法选择2008年1月至2015年1月湖北省第三人民医院收治的接受腹腔镜手术的患者600例,依据建腔方式的不同分为3组：IUPU法组200例,采取IUPU法建立后腹腔；手指法组200例,采取手指分离法建立后腹腔；气囊法组200例,采取自制气囊法建立后腹腔。比较3种术式的建腔时间、术中出血量、术中术后并发症、曲卡切口愈合状况。结果 IUPU法组、手指法组、气囊法组建腔时间分别为(4．2±1．3) min、(5．3±2．9) min、(7．4±3．3) min,差异有统计学意义(P<0．05),术中出血量比较差异无统计学意义( P>0．05)。气囊法组1例患者因气囊破裂转为开放性手术,其余患者均成功构建后腹膜腔；三组患者术后均未见严重并发症。各组患者曲卡切口愈合状况良好。结论 IUPU法、气囊法、手指分离法均可为术者创造可操作的后腹腔手术空间,气囊法用时最长,且存在破损的风险,患者术后腰肋部外凸；IUPU法最简洁,用时最少,切口最小；而手指分离法的优劣性介于两者之间。采用IUPU法构建后腹膜腔更为简单、省时,值得在临床上普及。