腹腔镜与开放保留肾单位手术治疗小肾癌的临床比较

A Comparative Study of Laparoscopic and Open Nephron Sparing Surgery for Small Renal Cell Carcinoma

目的通过腹腔镜保留肾单位手术(LNSS)与开放保留肾单位手术(ONSS)切除小肾癌的临床指标的对比研究,评价腹腔镜保留肾单位手术治疗小肾癌的安全性和有效性。方法选取本中心2009年6月至2011年6月期间行保留肾单位手术治疗的小肾癌患者51例,其中27例行腹腔镜保留肾单位手术,余24例行开放保留肾单位手术。对两组患者肿瘤大小、手术时间、肾脏热缺血时间、术中出血量、输血例数、引流管留置时间、术后住院时间、切口长度、相关并发症、术前及术后3个月患侧肾的肾小球滤过率(GFR)等指标进行回顾性分析。结果 51例患者均成功施行保留肾单位手术,患者年龄、性别、肿瘤大小、肿瘤侧别、术前患肾GFR、术后引流管留置时间、术后3个月患肾功能等均没有明显差异;手术时间、术中出血量、切口长度、并发症、术后住院天数等,LNSS组明显低于ONSS组(P<0.05);肾脏热缺血时间,LNSS组明显长于ONSS组(P<0.05)。结论腹腔镜保留肾单位手术能完整切除肿瘤,有效控制术中出血,最大限度的保留肾单位,保护肾脏功能。与开放保留肾单位手术相比,LNSS是一种创伤小、手术时间短、并发症少、术后恢复快的手术方式,是治疗小肾癌的有效方法。

Objective To evaluate the safety and effectiveness of laparoscopic nephron-sparing surgery.Methods 51 patients who underwent NSS for small renal cell carcinoma from June 2009 to June 2011 were entered this retrospective analysis.LNSS were performed in 27 patients,and open nephron-sparing surgery were performed in the other 24 patients.We collected clinical data to estimate the clinical effect of LNSS,including the tumor size,operation time,ischamia time,intraoperative blood loss,blood transfusion,postoperative drainage,the drainage tube indwelling time,postoperative hospital stay,complications,length of incision,preoperative and postoperative GFR of the operative side kidney.Results All the 51 cases were performed with NSS successfully.Between the LNSS and the ONSS group,there are not significant differences in age,gender,tumor size,tumor side,drainage tube indwelling time,preoperative and postoperative renal function.But the LNSS group has obviously less operation time,less intraoperative blood loss,less length of the incision,fewer complications,fewer postoperative hospital stay and more ischemia time.Conclusions We can completely remove the tumor,effectively control the bleeding and protect the renal function by LNSS.Compared to ONSS,LNSS has the advantages of less invasive,less operation time,fewer complications,and faster recovery.It is a very effective operation method for SRCC.