不同保留肾单位术式治疗局限性肾癌临床效果的对比研究

目的:对比经腹腹腔镜、腹膜后腹腔镜和开放手术3种保留肾单位手术方式治疗局限性肾癌的临床效果.方法:回顾分析67例局限性肾癌患者的临床资料.根据术式分为3组,A组为经腹腹腔镜保留肾单位肿瘤切除组（22例）；B组为腹膜后腹腔镜手术组（21例）；C组为开放手术组（24例）.对比3组患者手术时间、肾脏热缺血时间、术中出血量、住...

The comparative study on clinical effects of different nephron-sparing surgical methods for localized renal carcinoma

Objective:To compare the clinical effect of three different nephron-sparing surgical methods including peritoneal laparoscopy,retroperitoneal laparoscopy and open surgery for localized renal carcinoma.Methods:The clinical data of 67 patients with localized renal carcinoma was retrospectively analyzed.According to the methods of operation,they were divided into three groups,group A∶ 22 patients underwent peritoneal laparoscopic excision,group B∶ 21 patients underwent retroperitoneal laparoscopic excision and group C∶ 24 patients underwent open surgery.The operating time,renal warm ischemia time,blood loss,hospital stay,postoperative recurrence and metastasis were compared among the three groups and were statistically analyzed.Results:All of the operations were successful.63 specimens were proved clear cell carcinoma and 4 specimens were proved granular cell carcinoma by pathology examination.All of them were in renal capsule and the margin tissues were negative.The operation time of group A,group B and group C were(118.7±27.9) min,(110.8±26.5) min and(106.4±25.5) min respectively.There was no statistically significant difference in them(P>0.05).Renal warm ischemia time were(24.2±13.1) min,(23.6±12.9) min and(14.2±4.5) min respectively.The volumes of blood loss were(125.4±42.0) ml,(116.5±37.3) ml and(254.6±128.5) ml respectively.The time of hospital stay were(11.2±3.0) d,(10.1±1.8) d and(16.2±3.2) d respectively.There was statistically significant difference in group C vs group A and group B in the three terms above(P<0.05) and there was no statistically significant difference between group A and group B(P>0.05).All of the patients were followed up 8 to 60 months,1 case of tumor local recurrence in group B and 1 case of solitary pulmonary metastasis in group C were found.They were cured by re-operation.There was no statistically significant difference among the three groups(P>0.0167).Conclusions:Peritoneal laparoscopic and retroperitoneal laparoscopic nephron-sparing surgery for localized renal carcinoma have the advantages of minimal invasion,quick recovery and equal clinical effect with open surgery,and can substitute for open surgery.