后腹腔镜根治性肾切除术治疗局限性肾癌的疗效研究

目的 研究后腹腔镜根治性肾切除术(laparoscopic radical nephrectomy,LRN)治疗局限性肾癌的效果及安全性.方法 选择局限性肾癌患者80例,分为LRN组39例和传统开放肾癌根治术(open radical nephrectomy,ORN)41例(ORN组),比较两组的临床疗效.结果 与ORN组相比,LRN组手术时间、住院时间、术后肠功能恢复时间、术中出血量、白细胞、C-反应蛋白、肌酐和尿素氮均明显降低(P<0.05);LRN组的切口感染、术后出血、深静脉血栓形成、肺部感染、气胸、泌尿系统感染等并发症发生率为12.82%,明显低于对照组的29.27%(P<0.05);随访3~30个月,LRN组有1例术后5个月出现双肺转移,经口服索拉非尼后,现在病情已平稳;ORN组有1例术后4个月出现双肺转移,2例术后1年出现肿瘤全身转移.结论 后腹腔镜根治性肾切除术治疗局限性肾癌安全、有效,与传统开放手术相比,具有术后恢复快、创伤小、并发症少等优点,临床应用价值更高.

Clinical Efficacy of Retroperitoneal Laparoscopic Radical Nephrectomy for Localized Renal Cell Carcinoma

Objective To investigate the clinical effect of retroperitoneal laparoscopic radical nephrectomy for localized renal cell carcinoma .Methods 80 cases of localized renal cell carcinoma were divided into LRN group with 39 cases and ORN group with 41 cases.Clinical efficacy of the 2 groups was compared.Results Compared with ORN group,the operation time,hos-pitalization time,postoperative intestinal function recovery time ,intraoperative bleeding,white blood cells,C reactive protein,cre-atinine and urea nitrogen in LRN group were significantly lower (P<0.05);the incidence rate of incision infection ,postoperative bleeding,deep venous thrombosis ,pulmonary infection,pneumothorax and urinary system infection in LRN group was 12.82%, which was significantly lower than that of the control group ,29.27%( P<0.05);during 3~30 months follow-up,LRN group had 1 case of double lung metastasis 5 months after surgery ,after oral administration of sorafenib , the condition was stable;ORN group had 1 case of double lung metastasis 4 months after surgery ,2 cases of systemic tumor metastasis .Conclusion Retroperitoneal laparoscopic radical nephrectomy is safe and effective for localized renal cell carcinoma ,compared with open radical nephrectomy , it has the advantage of quick recovery ,less trauma,less complications,and higher clinical application value .