单孔与标准腹腔镜下无功能肾切除术的临床疗效对比

目的 比较经脐单孔多通道腹腔镜与标准经腹腹腔镜下行无功能肾切除术的治疗效果。 方法 2009年9月至2013年8月,本单位同一手术组完成无功能肾切除微创手术72例,其中50例行标准经腹腹腔镜手术,22例行经脐单孔多通道腹腔镜手术,回顾性分析50例标准经腹腹腔镜无功能肾切除术(A组)和22例经脐单孔多通道腹腔镜无功能肾切除术术(B组)的临床资料。两组的配比因素为患者年龄、性别、体质指数、无功能肾位置。 结果 72例手术均获成功,无中转开放手术。A、B两组的术后疼痛评分分别为(4.3±1.0)、(3.7±0.8)(p=0.015)、术后肠通气恢复时间分别为(58.1±16.1h)、(49.2±14.0h)(p=0.032),术后留置引流管时间分别为(3.9±1.5天)、(2.8±1.1天)(p=0.003),术后住院天数分别为(7.3±3.1天)、(6.3±3.4天)(p=0.048),手术切口满意度评分分别为(7.4±0.9)、(8.0±0.6)(p＝0.001),均有统计学差异(P＜0.05)。A、B两组的手术时间分别为(200.2±59.7min)、(185.8±55.4min)(p=0.299),术中出血量分别为(173.2±112.9ml)、(134.1±82.2ml)(p=0.168),均无统计学意义(P＞0.05)。 结论 与标准经腹腹腔镜下无功能肾切除相比,经脐单孔多通道腹腔镜手术的患者术后疼痛轻,肠道功能恢复快,引流管拔除时间早,术后住院天数短,切口满意度高,因此,经脐单孔多通道腹腔镜下无功能肾切除术是一种安全、有效、可靠的微创治疗方法。但无功能肾切除术后,患者的远期治疗效果仍需进一步长期随访予以证实。

Standard laparoscopic vs laparoendoscopic single-site nephrectomy for benign nonfunctioning kidney: a comparison of therapeutic outcomes

Objective To compare the therapeutic outcomes of standard laparoscopic and laparoendoscopic single-site (LESS) nephrectomy for benign nonfunctioning kidney. Methods From September 2009 to August 2013, a single urologist group in our center performed 72 transperitoneal laparoscopic nephrectomies for benign nonfunctioning kidney, with 50 undergoing LESS (group A) and 22 undergoing standard laparoscopic surgery (group B). The clinical data of the two groups were analyzed and the therapeutic outcomes were compared between the two groups. Results The operation was successfully performed in all cases,with no conversion to open surgery. Compared with standard laparoscopic group, the LESS group had significantly lower postoperative pain score (4.3±1.0 vs 3.7±0.8, P=0.015),quicker bowel function recovery (58.1±16.1] h vs 49.2±14.0] h,P=0.032),shorter drainage duration (3.9±1.5] d vs 2.8±1.1] d,P=0.003),shorter post-operative hospital stay (7.3±3.1] d vs 6.3±3.4] d,P=0.048), and a better cosmetic satisfaction score (7.4±0.9 vs 8.0±0.6, P=0.001). The operative time and intraoperation blood loss were not significantly different between the two groups. Conclusion Compared to standard laparoscopic nephrectomy, transumbilical LESS nephrectomy offers a quicker recovery of bowel function,shorter drainage duration,a better postoperative pain control,and a better cosmetic satisfaction for benign nonfunctioning kidney,but its long-term therapeutic effect needs to be further verified.