腹腔镜和开放根治性肾切除术治疗T2期肾癌的临床疗效比较

目的 比较腹腔镜和开放行根治性肾切除术治疗T2期肾癌的临床效果。方法 对同期138例肾癌患者分别行腹腔镜或开放根治性肾切除术，腹腔镜手术组63例，开放手术组75例。比较两组术中出血量、手术时间、术后进食时间及住院时间等指标。结果 腹腔镜肾根治性切除术手术时间为90~385min，平均（213±61.6）min；开放手术时间为55~320 min，平均（173±52.3）min，二者差异有统计学意义（P=0.000）。腹腔镜手术组术中失血量为30~1 600 ml，平均（220±291.8）ml；开放手术组术中失血量为50~1400 ml，平均（319±244.1）ml，差异有统计学意义（P=0.032）。经腹腹腔镜组术后1～4d进食，平均（2.4±0.82）d；经后腹膜腹腔镜组为术后2～5 d进食，平均（3.1±1.02）d，差异有统计学意义（P=0.000)。经腹腹腔镜组术后住院4～15 d，平均（7.3±2.50）d；经后腹膜腹腔镜组术后住院6～15 d，平均（9.3±2.25）d，差异有统计学意义（P=0.000)。结论 腹腔镜根治性肾切除术有出血少、术后进食早和术后住院时间短等优点，术后并发症发生率和开放手术相近，腹腔镜根治性肾切除术治疗T2期肾癌安全可行。

Laparoscopic radical nephrectomy and open radical nephrectomy for stage T2 renal cell carcinoma patients: a comparison of clinical outcomes

Objective To compare the efficacy of laparoscopic radical nephrectomy(LRN) and open radical nephrectomy(ORN) for clinical stage T2 renal cell carcinoma. Methods A total of 138 patients underwent radical nephrectomy for renal cell carcinoma, including 63 by LRN and 75 by ORN. Renal cell carcinoma was pathologically confirmed in all the patients. The patients were followed up for 5-36 months, with a median of 24 months. The surgical blood loss, operation time, and time of starting food postoperatively, and hospital stay were compared between the two groups. Results The operation time was 90-385 min (a mean of 213±61.6] min) for LRN and 55-320 min (a mean of 173±52.3] min)for ORN (P=0.000). The blood loss was 30-1 600 ml (a mean of 220±291.8] ml) for LRN and 50-1 400 ml (a mean of 319±244.1] ml) for ORN (P=0.032). The fasting period of surgery was 1-4 d (a mean of 2.4±0.82] d) for LRN and 2-5 d (a mean of 3.1±1.02] d) for ORN(P=0.000).The hospital stay was 4-15 d (a mean of 7.3±2.50] d) for LRN and 6-15 d (a mean of 9.3±2.25] d) for ORN (P=0.000). Conclusion The efficacy of LRN is similar to that of ORN. LRN has the advantages of minimal invasiveness and rapid postoperative recovery. The complication of LRN is similar to ORN, and it might be an alternative treatment for clinical T2 stage renal cell carcinomas.