经腹腔与腹膜后腹腔镜肾癌根治术疗效比较

目的比较经腹腔与经腹膜后入路腹腔镜肾癌根治术的临床效果。方法分析2010年4月至2012年2月间在北京大学第一医院接受腹腔镜肾癌根治术的141例患者资料,其中经腹腔入路组61例、经腹膜后腔入路组80例,比较两种手术入路患者在手术时间、出血量、术后住院日等方面的差异。结果所有141例手术均在腹腔镜下完成。对于经腹腔入路组和经腹膜后腔组,平均手术时间分别为192.1及147.2min（P=0.000）;平均术后住院日分别为5.8d及7.2d（P=0.000）;平均肿瘤长径分别为5.6cm及4.3cm（P=0.001）。在术中出血量、并发症及输血情况等方面无显著性差异。结论经腹腹腔镜和经后腹膜腹腔镜肾癌根治术围手术期均有良好效果,经腹腔入路适合治疗体积较大的肿瘤,术后恢复快,而经腹膜后腔入路具有手术时间短的优势。

Comparison of clinical outcomes of transperitoneal versus retroperitoneal laparoscopic radical nephrectomy

Objective To compare the clinical outcomes of transperitoneal and retroperitoneal laparoscopic radical nephrectomy,and to identify the indicators for both approaches.Methods We collected and analyzed the clinical data of 141 patients who underwent laparoscopic radical nephrectomy（61 transperitoneal and 80 retroperitoneal nephrectomy） from Apr.2010 to Feb.2012,and compared the operation time,blood loss,postoperative hospital stay and other clinical outcomes between the transperitoneal and retroperitoneal approach.Results All operations were successfully conducted by laparoscopic procedures.For the transperitoneal and retroperitoneal approach,the mean operation time was 192.1 min and 147.2 min,respectively（P=0.000）;the mean post-operative hospital stay was 5.8 days and 7.2 days（P=0.000）,and the mean diameter of tumors was 5.6 cm and 4.3 cm（P=0.001）.However,the transperitoneal and retroperitoneal approaches were similar in terms of blood loss,complications and infusions.Conclusions Retroperitoneal and transperitoneal approaches yielded excellent short-term surgical outcomes.Transperitoneal approach is associated with a shorter hospital stay and is suitable for tumors with a larger size,while the retroperitoneal approach has a shorter operation time.