后腹腔镜肾部分切除术治疗局限性肾癌的疗效分析

目的探讨后腹腔镜肾部分切除术(RLPN)治疗局限性肾癌的疗效和安全性。方法 78例局限性肾癌患者随机分为腹两组,腹腔镜组(RLPN)共45例,开放组(OPN)共33例;记录手术时间,术中出血量、术中热缺血时间、手术前后患肾肾小球滤过率、术后引流量、胃肠道功能恢复时间、术后住院时间、并发症发生率、及肿瘤学效果,并进行统计学分析。结果全部手术均获成功。两组患者在围手术期并发症的发生率、患肾术后肾小球滤过率下降幅度等方面差异无统计学意义,RLPN组与OPN组相比,手术时间及术中肾脏热缺血时间长,差异有统计学意叉(P<0.05);RLPN组出血量、胃肠道功能恢复时间、术后住院天数等方面均明显优于OPN组(P<0.05)。平均随访时间18(1³6)个月,两组患者均未见肿瘤复发及转移。结论与开放术式比较,后腹腔镜下肾部分切除术是一种安全、有效的手术方式,而且具有创伤小、恢复快、住院时间短等优点。

The Curative Effects of Retroperitoneal Laparoscopic Partial Nephrectomy in the Treatment of Localized Renal Cell Carcinoma

Objective To evaluate the efficacy and safety of retroperitoneoscopic partial nephrectomy （RLPN） in the treatment of localized renal cell carcinoma. Methods 78 cases of renal tumors were randomly divided into two groups：45 cases underwent retroperitoneoscopic partial nephrectomy （RLPN）;33 cases underwent open partial nephrectomies（OPN）;variables compared included operation time, warm ischemic time, blood loss, amount of drainage,time of anal exsufflation, postoperative hospital stay, postoperative complication, glomerular filtration rate（GFR）and oncological results before and after partial nephrectomy. Results All procedures were successful performed. There was no significant difference in postoperative complication, amount of drainage and GFR of（P〉0.05）. OPN group was superior to RLPN group in the operation time, warm ischemia time,（P〈0.05）. But in blood loss, time of anal exsufflation, and postoperative hospital stay OPN group was inferior to RLPN group（P〈0.05）. During the follow up of 1 to 36 months, no tumor recurrence or metastasis developed in the two groups. Conclusions Retroperitoneoscopic partial nephrectomy can be performed in a safe and effective manner comparable to open partial nephrectomies, and has the advantages of minimal invasion and shorter hospital stay.