后腹腔镜肾癌根治术的临床疗效评估(附67例报告)

目的评价后腹腔镜肾癌根治性切除术（retroperitoneal hparoscopic radical nephrectomy，LRN）与开放性肾癌根治性切除术（open radical nephrectomy，ORN）的临床效果。方法回顾性分析和比较后腹腔镜肾癌根治性切除术（34例，A组）与开放性肾癌根治性切除术（33例，B组）患者的临床资料，比较两种方法的手术时间、术中出血、术后引流、术后最早下床活动时间、肠功能恢复、术后住院时间、术后镇痛剂使用量、术中术后输血、血浆量、术后随访时间及手术效果。结果A组中1例因最初对解剖结构难于辨认，无法分离肾前筋膜至肾门而改开放手术，1例因损伤精索静脉出血难以控制而改开放手术，1例因肾周脂肪过多无法将肾脏掀起显露肾蒂而玫开放手术。31例手术成功；B组手术均成功，1例术后2个月因大面积脑出血死亡。余均无瘤生存。两组病例比较术中出血、术后引流、术后最早下床活动时间、肠功能恢复、术后住院时间、术后镇痛剂使用量、术中术后输血、血浆量差异有显著性（P〈0.01），而肿瘤大小、手术时间、随访时间差异无显著性（P〉0．05）。结论与传统的开放性肾癌根治性切除术相比，后腹腔镜肾癌根治性切除术虽然技术难度大，但其具有微创、痛苦小、恢复快、并发症少等优点，而对T1N0M0和T2N0M0期肿瘤控制，临床疗效相同。

Clinical practice and study of retroperitoneal laparoscopic radical nephrectomy

Objective] To evaluate the clinical efficacy of retroperitoneal laparoscopic radical nephrectomy and open radical nephrectomy. Mathods] Between November 2003 and December 2005, 67 patients with renal cell carcinoma underwent retroperitoneal laparoscopic radical nephrectomy (34 patients, group A) and open radical nephrectomy (33 patients, group B). Operating time, blood loss, amount of postoperative drainage, time to ambulation, recovery of intestinal function after operation, the postoperative hospital stay, use of antalgesic and transfusion blood and plasma were compared between group A and group B, retrospectively. Results] In group A, the operations of 31 patients were successful and 3 cases were failed, then conversed to open surgery. At first, one case was not decented the prerenal fascia and the other two cases occurred complications, one case was due to injurying genital gland vein, with blood loss of 500 ml, another fatty renal capsula was too much thick to explose the renal pedicle. The operations of group B were all successful, only one case was died of intracerebral hemorrhage after two monthes. In group A, blood loss, amount of postoperative drainage, time to ambulation, recovery of intestinal function after operation, hospital stay, use of antalgesic and transfusion blood and plasma were significantly reduced than those of group B (P <0.01), while the tumor size, operating time and the time of follow-up were no significantly different (P >0.05) between two groups. Conclusions] As compared with open radical nephrectomy, retroperitoneal laparoscopic radical nephrectomy, although technically demanding, affords patients with renal cell carcinoma an improved postoperative course with minimal invasion, less pain, quicker recovery and less complications, while providing effective cancer control for patient with T1N0M0 and T2N0M0 tumor.