经胸腹联合切口及胁腹切口肾切除术治疗巨大肾肿瘤的疗效比较

目的比较经胸腹联合切口及经胁腹切口肾切除术治疗巨大肾肿瘤的临床疗效。方法回顾性分析两种手术方法治疗194例巨大肾肿瘤患者的疗效，其中经胁腹切口96例（A组），经胸腹联合切口98例（B组）。对两组患者的手术时间、术中失血、肿瘤大小、血管内癌栓清除率、止痛剂使用、术后拔除引流管时间和住院时间等进行统计分析，并对患者长期随访和问卷调查（随访时间8-30个月，平均22．5个月），比较两组术后疼痛消失时间、术后停止使用止痛药时间、术后恢复正常活动时间、术后恢复工作时间等情况。结果收回有效问卷A组56例（58．3％），B组60例（61．2％）。两组手术均获成功，两组患者性别构成、年龄具有可比性（P〉0．05）。A组平均手术时间、术中出血量、肿瘤大小及拔除引流管时间分别为155．6±10．8min、209．9±12．6ml、17．8±2．2cm和3．82±0．66d，B组分别为123．6±4．9min、150．2±10．0ml、20．2±2．2cm、3．27±0．52d，两组差异有统计学意义（P〈0．001）。B组血管内癌栓清除率明显高于A组。而术后使用止痛药的病例数、下床活动时间、住院时间、术后使用止痛药时间、术后疼痛消失时间、术后恢复正常活动时问及术后恢复T作等方面两组差异无统计学意义（P〉0．05）。结论与传统的经胁腹切口肾切除术相比，经胸腹联合切口肾切除术具有显露好、视野开阔，手术时间短、出血少等优点，是一种安全、有效的治疗方法。

A Prospective Study of Efficacy of Thoracoabdominal Incision for Nephrectomy: A Comparison with the Flank Approach

Objective The efficacy and morbidity of thoracoabdominal incision in comparison with flank incision for radical nephrectomy are unknown.This retrospective study was performed to compare the outcome of thoracoabdominal incision versus flank incision for radical nephrectomy in patients with large renal tumors.Methods A questionnaire assessing the time of postoperative pain,use of anodyne and return to daily activities and work was sent to patients who underwent radical nephrectomy through the 11th rib(flank incision,group A,96 patients)or the 9th to 10th rib(thoracoabdominal incision,group B,98 patients)from 2003 to 2008 at the Second Xiangya Hospital in Changsha,China.A case retrospective analysis assessing operation time,perioperative hemorrhage volume,size of tumors,success in the treatment of tumor thrombus in renal vein or vena cava,presence of drainage-tube,postoperative analgesia usage and length of stay was done for patients whose questionnaires were returned.Results The length of operation time and the presence of abdominal drainage-tube was shorter in the thoracoabdominal incision group(group B)than in the flank incision group(group A).The perioperative hemorrhage volume in group B was less than that in group A.The mean size of tumors in group A was smaller than that in group B(P<0.000 5).The success rate in the treatment of thrombus in renal vein or vena cava in group B was higher than that in group A(P<0.05).The length of off-bed time and of hospital stay were similar in both groups.There were no significant differences between the groups in pain severity postoperative day 1,on the day of discharge and 1 month postoperatively(P>0.05).There were no significant differences between the groups in the time from surgery to the complete disappearence of pain,to the discontinuation of pain medication,and to the return to daily activities and work(P>0.05).Conclusion The approach of thoracoabdominal incision provides better exposure.Morbidity is comparable for thoracoabdominal and flank incisions in terms of incisional pain,analgesic requirements after discharge and return to normal activities.