后腹腔镜与开放手术行肾部分切除术治疗肾肿瘤的临床效果比较

目的：通过与开放性肾部分切除术（OPN）的临床效果比较，评价后腹腔镜肾部分切除术（LPN）的临床价值。方法：回顾性分析后腹腔镜肾部分切除术（38例，LPN手术组）和同期施行开放性肾部分切除术（46例，OPN手术组）的临床资料，就两组患者一般资料、手术时间、患肾热缺血时间、术中出血量、术后肠道功能恢复时间、术后止痛药用量、术后住院天数、术后血清肌酐升高幅度及术后并发症等指标进行比较。根据数据类型选用x2检验、两样本t检验或Wilcoxon秩和检验，以P〈0．05为差异有统计学意义。结果：两组患者的一般资料差异无统计学意义（P〉0．05），具有可比性。LPN手术组在术中出血量、术后肠道功能恢复时间、术后止痛药用量、术后住院天数方面及术后并发症发生率均优于DPN手术组（P〈0．05），但前者的患肾热缺血时间明显长于后者（P〈0．05）。LPN手术组和OPN手术组的手术时间及术后血清肌酐升高幅度差异无统计学意义（P〉0．05）。两组患者送检标本的手术切缘均为阴性，随访18个月均无一例复发。结论：后腹腔镜肾部分切除术治疗肾肿瘤疗效肯定，与传统的开放性肾部分切除术相比，具有创伤小、恢复快、疗效与开放性手术相当等优点，是目前治疗肾肿瘤较理想的手术方法，值得进一步推广。

A Comparison of the Clinical Effects Between Retroperitoneal Laparoscopic and Open Partial Nephrectomy for the Treatment of Renal Tumor

Objective：To assess the clinical value of retroperitoneal laparoscopic partial nephrectomy（LPN）by comparing its clinical effects with open partial nephrectomy（OPN）. Methods：Clinical data about 38 cases （group LPN） and 46 cases （group OPN） with renal tumor respectively treated by retroperitoneal laparoscopic and open partial nephrectomy were analyzed retrospectively. The demographics of patients, operation time, warm ischemia time of kidney, intraoperative blood loss , postoperative recovery time of intestinal function, analgesic dosage, postoperative hospital stay, changes in postoperative serum creatinine level and complications of 2 groups were compared by student-test, chi-square test and Wilcoxon rank sum test for statistical analysis according to data types. Statistical significance was defined as P〈0.05. Results： There are no significant differences in the demographics of patients between two groups, so they are comparable. Group LPN in intraoperative blood loss, postoperative recovery time of intestinal function, analgesic dosage, postoperative hospital stay and postoperative complications are superior to group OPN, statistical differences are significant （P〈0.05）. There are no significant differences in operation time and changes in postoperative serum creatinine level between two groups （P〉0.05）, but warm ischemia time of kidney in group LPN is significantly longer than group OPN （P〈0.05）. Pathological examination shows that surgical margin of tumor in all cases are negative. No recurrence of tumor happens in i8 months follow-up. Conclusions：There is a definite therapeutic effect in retroperitoneal laparoscopic partial nephrectomy for treatment of renal tumor, and it has more advantages in less injury, rapid postoperative recovery, excellent effects than open partial nephrectomy, as a result, becomes a better alternative surgical method deservable to be further popularized for treatment of renal tumor.