腹腔镜与开放性肾部分切除术治疗小肾癌的安全性与疗效分析

目的 比较腹腔镜与开放性肾部分切除术治疗小肾癌的安全性与近期治疗效果.方法 2004年1月至2009年3月T1aN0M0的肾癌患者110例,均接受肾部分切除术,其中腹腔镜肾部分切除术(LPN)52例(LPN组),开放性肾部分切除术(OPN)58例(OPN组).评估患者的手术时间、肾动脉阻断时间、手术并发症、术后恢复和手术切缘情况.结果 LPN组和OPN组的平均手术时间分别为177.8和126.7 min(P<0.01),肾动脉阻断时间分别为28.3和21.9 min(P>0.05);两组各有2例(3.8%)和1例(1.7%)需要输血(P>0.05);手术前后肌苷变化两组差异无统计学意义(P>0.05);两组分别有6例(11.5%)和8例(13.8%)需缝合集合系统(P>0.05);分别有6例(11.5%)和8例(13.8%)术后出现血尿(P>0.05);未出现尿瘘或其他严重的并发症.患者的手术切缘均为阴性.两组患者平均术后住院天数差异有统计学意义(P<0.01).结论 LPN的安全性和治疗效果与OPN相同,但术后恢复快于OPN.对于经选择的患者和有丰富经验的医师,可以考虑将LPN作为治疗T1aN0M0肾癌的首选术式.

Analysis of safety and efficacy of laparoscopic and open partial nephrectomy for small renal cell carcinoma

Objective To compare the safety and efficacy of laparoscopic and open partial nephrectomy for small renal cell carcinoma. Methods To collect and analyze the data such as operation time, warm ischemia time, complications, recovery and surgical margins of 110 patients of small renal carcinoma (T1aN0M0) from January 2004 to March 2009, 52 of which underwent laparoscopic partial nephrectomy (LPN) and the other 58 patients underwent open partial nephrectomy (OPN). Results The mean operation time of LPN group and OPN group were 177.8 min and 126. 7 min ( t = 3. 973, P < 0. 01 ),respectively. The warm ischemia time of the two groups were 28.3 min and 21.9 min ( t = 4. 627, P >0. 05) , respectively. Two cases in LPN group and 1 case in OPN group(3.8% vs 1.7% , x2 =0. 010,P >0. 05 ) needed blood transfusion. The increment of creatine after operation were 4 μmol/L in LPN group and 6 μmol/L in OPN group (t = -2.018,P >0.05). Six cases (11.5%) in LPN group and 8 cases (13.8%) in OPN group needed collection system reparing (x2 = 0. 130,P > 0. 05 )and the same data of hematuria after operation was observed. There was no urinary fistula or other severe complications in all patients. The hospital stay after operation was 10. 6 d and 12. 9 d ( t = - 3. 244, P < 0. 01 ) in the two groups, respectively. All surgical margins were negative. Conclusion LPN and OPN have the same safety and efficacy, LPN primary treatment can be used for selected patients of T1aN0M0 renal cell carcinoma because of its fast recovery.