经腹入路与后腹腔入路腹腔镜下保留肾单位手术治疗肾错构瘤的疗效分析

目的:探讨经腹入路与后腹腔入路腹腔镜下保留肾单位手术治疗肾错构瘤（RAML）的疗效和安全性。方法:回顾性分析我院2013年1月至2017年10月收治的39例RAML患者的临床资料，根据手术方式分为两组，经腹入路腹腔镜保留肾单位手术（TLNSS）组21例，后腹腔入路腹腔镜保留肾单位手术（RLNSS）组18例，比较两组患者的一般资料、手术及术后相关指标，评价两种手术方式的疗效。结果:两组患者性别、年龄、肿瘤直径等一般资料差异无统计学意义（P>0.05）；影像学检查中TLNSS组患者肿瘤位于腹侧例数明显多于RLNSS组，RLNSS组患者肿瘤位于腰侧例数明显多于TLNSS组，差异有统计学意义（P<0.05）；TLNSS和RLNSS组手术时间分别为（168.8±70.0）min、（120.5±53.9）min，术后肠道功能恢复时间分别为（72.5±20.2）h、（53.4±15.1）h，TLNSS组手术时间、术后肠道功能恢复时间均长于RLNSS组，差异有统计学意义（P<0.05）。结论:经腹入路与后腹腔入路腹腔镜下保留肾单位手术治疗RAML的方法均是安全有效的，两种手术方式各有利弊，经腹入路适合肿瘤处理难度相对较大、位于肾脏腰侧以外的患者，操作空间大，经后腹腔入路适合肿瘤位于肾脏腹侧以外的患者，术后恢复快。

Efficacy and safety of transperitoneal approach and retroperitoneal approach laparoscopic nephron-sparing surgery for the treatment of renal hamartoma

Objective: To explore the efficacy and safety of transperitoneal and retroperitoneal laparoscopic nephron-sparing surgeries in the treatment of renal hamartoma (RAML).Methods:We retrospectively analyzed and summarized the clinical data of 39 patients with RAML treated in our hospital from January 2013 to October 2017.According to the operation method，the patients were divided into two groups:21 cases undergoing transperitoneal laparoscopic nephron-sparing sugery（TLNSS） and 18 cases after retroperitoneal laparoscopic nephron-sparing sugery（RLNSS）.The general data，operation and postoperative related indexes of two groups were compared to evaluate the curative effect of the two surgical methods.Results:There was no significant difference in general data such as gender，age，tumor diameter between the two groups (P>0.05).In the imaging examination，the number of tumors in the TLNSS group was significantly higher on the ventral side than in the RLNSS group，while the number of tumors on the lumbar side in the RLNSS group was significantly more than that on the TLNSS group (P<0.05).The operation time of TLNSS group and RLNSS group were (168.8±70.0) min and (120.5±53.9) min respectively，and the recovery time of intestinal function were (72.5±20.2)h and (53.4±15.1)h.The recovery time of intestinal function after operation was longer than that of RLNSS group and the difference was statistically significant (P<0.05).Conclusion:It is safe and effective to treat RAML with laparoscopic by transperitoneal and retroperitoneal.The two surgical methods have their own advantages and disadvantages，transperitoneal suitable for tumor treatment is relatively difficult，located in the kidney outside the waist side of patients，which have a large operating space.And the retroperitoneal is suitable for patients with tumors located outside the ventral side of the kidney with rapid postoperative recovery.