后腹腔镜与开放肾癌根治性手术的回顾性比较

目的回顾性比较后腹腔镜下肾癌根治术与开放性肾癌根治术的临床疗效。方法回顾性分析68例后腹腔镜肾癌根治性手术及52例开放肾癌根治性手术患者的临床资料，比较两种术式在手术时间、术中估计出血量、术后镇痛药物使用剂量、胃肠道功能恢复时间、下床活动时间及术后住院时间等方面的差异。结果后腹腔镜组与开放手术组患者在性别、年龄、肿瘤位置、肿瘤大小及肿瘤分级上的差别无统计学意义。所有手术均获成功，均未输血。后腹腔镜组平均手术时间（138．4±36．2）min较开放组手术时间（112．3±32．5）min长，但二者之间差异无统计学意义。开放组术中估计出血量（298．1±19．5）ml，后腹腔镜组估计出血量（123．6±24．6）ml，二者差异有统计学意义。后腹腔镜组在镇痛药用量、胃肠道功能恢复时间、下床活动时间及术后住院日等方面均明显优于开放组（P〈0．05）。术后随访3个月至3年，两组均无肿瘤复发，未见操作通道部位或后腹腔内种植。结论与传统开放手术相比，后腹腔镜肾癌根治性手术具有出血少、创伤小、患者痛苦少、恢复快、住院时间短等特点。

Retrospective comparison of retroperitoneoscopic versus open radical nephrectomy for renal carcinoma

Objective To compare the clinical outcomes of retroperitoneoscopic and open radical nephrectomy for renal carcinoma. Methods clinical date of 68 patients who underwent retroperitoneoscopic radical nephrectomy were retrospectively compared with those of 52 patients who underwent open radical nephrectomy for renal carcinoma, including patient demographic date, perioperative indexs and clinical outcomes. Results There were no significant differences in age, sex, tumor size and the tumor grade in the two groups. In the comparison of intraoperative parameters in the two groups, there was no significant difference in the operative time(138.4±36.2 min vs 112.3±32.5 min, P<0.05), but the intraoperative estimated blood loss in the retroperitoneoscopic group showed significant advantages(123.6±24.6ml vs 298.1±19.5ml, P<0.05) .Comparision of postoperative parameters showed that the use of analgesic, resumption of oral intake and postoperative hospital stay were better in the retroperitoneoscopic than in the open group(30.5±12.3 mg vs 115.8±17.4 mg, 27.6±6.4 h vs 42.8±7.8 h, 5.2±1.9 d vs 8.3±2.3 d,respectively,each P<0.05).During the follow up of 3 to 36 months no tumor recurrence or metastasis developed in the two groups. Conclusion Comparison with open operation, retroperitoneoscopic radical nephrectomy for renal carcinoma is a minimally invasive and effective procedure.