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[儿童腹腔镜泌尿生殖系统手术中各种术中止血方法的应用]

[Using various methods of intraoperative hemostasis in laparoscopic genitourinary surgery in children].

作者信息

Turov F O, Yatsyk S P, Poddubnyi I V, Glybina T M, Bespalyuk O I

机构信息

National Medical Research Center of Childrens Health of Minzdrav of Russia, Moscow, Russia.

Morozovskaya Childrens City Clinical Hospital of MHD, Moscow, Russia.

出版信息

Urologiia. 2018 May(2):94-99.

Abstract

AIM

To improve treatment results of children undergoing laparoscopic genitourinary surgery by optimizing intraoperative hemostasis.

MATERIALS AND METHODS

The study comprised 110 children with various genitourinary diseases. The study group included 70 children who underwent laparoscopic surgery with optimized hemostasis with the use of an automated electrosurgical vessels ligation device LigaSure. Forty children who received standard intraoperative hemostasis with mono- or bipolar coagulation made up a control group.

RESULTS

The operative time was significantly shorter with the optimized method of hemostasis than when using mono- and bipolar coagulation [77.02 min versus 112.5 min (p<0.05)]. The blood loss in the study group was also significantly lower than in the control group [17.9 and 34.2 ml, respectively (p<0.05)] due to precise control and final hemostasis. There were no intraoperative complications and conversion to open surgery in patients in the optimized hemostasis group, whereas in the control group two complications were observed.

CONCLUSION

Laparoscopic urogenital surgery with the optimized hemostasis using the automated electrosurgical vessels ligation device LigaSure in children is optimal due to the minimal injury to the coagulated tissues, the ability to forgo clipping and ligation of the vessels, which results in shorter operative time and reduced intraoperative blood loss.

摘要

目的

通过优化术中止血来提高接受腹腔镜泌尿生殖系统手术儿童的治疗效果。

材料与方法

该研究纳入了110例患有各种泌尿生殖系统疾病的儿童。研究组包括70例接受使用自动电外科血管结扎设备LigaSure进行优化止血的腹腔镜手术的儿童。40例接受单极或双极电凝标准术中止血的儿童组成对照组。

结果

优化止血方法的手术时间明显短于使用单极和双极电凝时[分别为77.02分钟和112.5分钟(p<0.05)]。由于精确控制和最终止血,研究组的失血量也明显低于对照组[分别为17.9毫升和34.2毫升(p<0.05)]。优化止血组患者术中无并发症,也未转为开放手术,而对照组观察到两例并发症。

结论

在儿童中使用自动电外科血管结扎设备LigaSure进行优化止血的腹腔镜泌尿生殖系统手术是最佳选择,因为对凝血组织的损伤最小,能够避免血管夹闭和结扎,从而缩短手术时间并减少术中失血量。

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