单孔与标准腹腔镜肾部分切除术的临床疗效对比

目的 通过对比单孔腹腔镜和标准腹腔镜下肾部分切除术的临床疗效,探讨单孔腹腔镜肾部分切除术的手术特点及其安全性、可行性和优缺点.方法 2009年8月至2015年2月同一手术组完成的12例单孔腹腔镜肾部分切除术,选择手术日期相近、肿瘤大小和DAP评分类似、进行标准腹腔镜肾部分切除术的患者22例作为对照组,回顾性分析两组患者的临床资料,比较临床疗效.结果 两组共34例患者均顺利完成手术,无中转开放手术.两组患者的体质量指数、肿瘤大小、DAP评分差异均无统计学意义(P＞0.05).单孔组和标准腹腔镜组术后肠道恢复时间分别为(1.50±0.71)d和(2.45±0.96)d,疼痛评分分别为3.5±1.2和4.3±0.9,切口满意度评分分别为8.1±1.8和7.2±2.1,差异均有统计学意义(P＜0.05);手术时间分别为(213.1±33.9)min和(208.5±65.7)min,术中出血量分别为(92.7±66.8)mL和(162.3±168.1)mL、热缺血时间分别为(20.5±12.8)min和(19.5±7.5)min,差异均无统计学意义(P＞0.05).术前和术后1个月分别采用99mTc-DTPA测定双肾肾小球滤过率(GFR),单孔组和标准腹腔镜组患肾术后GFR较术前分别下降(3.7±8.6) mL/min和(8.9±10.1) mL/min,差异无统计学意义(P＞0.05).结论 单孔多通道腹腔镜肾切除术安全、有效,对于肿瘤直径较小、位置较好的肾肿瘤的治疗效果与标准腹腔镜相似.

Laparoendoscopic single-site nephrectomy and standard laparoscopic partial nephrectomy: a comparison of clinical efficacy

2. Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China : Objective To compare clinical outcomes of laparoendoscopic single-site(LESS) and traditional standard laparoscopy partial nephrectomy surgery, investigate the characteristics, safty and feasibility, advantages and disadvantages of LESS nephrectomy surgery. Methods The same surgical group completed 12 cases of LESS partial nephrectomy from August 2009 to February 2015 and we selected the 22 cases of standard laparoendoscopic partial nephrectomy in the same period to be control, which had similar tumor size, DAP scores. Clinical data was retrospectively analyzed to compare the clinical efficacy. Results All procedures were completed successfully without conversion to open cases. The body mass index, tumor size and DAP scores of the both groups were not statistically different (p> 0.05). The bowel recovery time, pain score, cutouts satisfaction scores of LESS group and standard group were respectively (1.50 ± 0.71) days and (2.45 ± 0.96) days, 3.5 ± 1.2 and 4.3 ± 0.9,8.1 ± 1.8 and 7.2 ± 2.1 with the statistically significant differences. The operation time, blood loss, warm ischemia time of LESS group and standard group were respectively was respectively (213.1 ± 33.9) min and (208.5 ± 65.7) min, (92.7 ± 66) ml and (162.3 ± 168.1) ml, (20.5 ± 12.8) min and (19.5 ± 7.5) min, with no statistical difference(p>0.05). Before and 1 month after the operation, renal glomerular filtration rate (GFR) were measured with 99mTc-DTPA, and LESS and standard laparoendoscopic group are suffering from kidney GFR decline (3.7 ± 8.6) ml/min and (8.9 ± 10.1) ml/min, with no statistical difference(p>0.05). Conclusion The LESS nephrectomy is safe and effective, which would have the similar outcomes with standard laparoendoscopic partial nephrectomy when the tumor are small and in the good position.