后腹腔入路与经腹入路腹腔镜下肾部分切除术治疗肾癌的临床比较

Clinical Efficacy Evaluation of Retroperitoneal and Transperitoneal Laparoscopic Partial Nephrectomy

目的:评价后腹腔入路与经腹入路腹腔镜下肾部分切除术治疗早期肾癌的临床效果。方法:回顾性分析后腹腔入路(17例,A组)与经腹入路(15例,B组)腹腔镜下肾部分切除术治疗早期肾癌患者的临床资料,A组肿瘤大小1.2～3.9(2.6±1.3)cm,B组肿瘤大小1.0～4.0(2.7±1.3)cm。两组术前临床分期均为T_1N_0M_0。比较两种方法的肿瘤大小、手术时间、术中失血量、热缺血时间、标本重量、恢复进食时间、住院时间及手术效果。结果:A组手术均成功,B组1例因肾动脉损伤出血中转开放手术。两组肿瘤大小(2.6±1.3 cm vs 2.7±1.3cm)、术中失血量(302±85mlvs305±90ml)、标本重量(42±31g vs 45±33 g)、热缺血时间(28±9.1 min vs30±9.2min)等方面无明显差异(P>0.05);A组在手术时间(175±55 min vs 248±70 min)、恢复进食时间(24±5 h vs 49±11 h)和住院时间(6.5±1.6天vs 8.4±1.9天)均少于B组(P<0.05)。结论:后腹腔入路与经腹入路腹腔镜下肾部分切除术均是治疗早期肾癌的一种微创和安全有效的治疗方法,后腹腔入路在手术时间、恢复进食时间及住院时间上少于经腹入路。

Objective：To evaluate the clinical efficacy of retroperitoneal and transperitoneal laparoscopic partial nephrectomy. Methods：From August 2004 to June 2008,32 patients with small renal cell carcinoma underwent retroperitoneal （ 17 patients, group A） and transperitoneal （ 15 patients, groupB） laparoseopic partial nephrectomy. The size of renal neoplasms was 1.2-3.9（2.6±1.3）cm in group A and 1.0-4.0（2.7±1.3）em in group B respectively. The preoperative clinical stage was T1 No M0 in two groups. Tumor size,operative time, blood loss, warm ischemia time,specimen weight, tolerating regular diet time and the postoperative hospital stay were compared between group A and group B , respectively. Results： The operations of group A were all successful,In group B, 1 case was failed and conversed to open surgery. Tumor size （2.6±1.3 em versus 2.7±1.3 era） ,blood loss（302±85 ml versus 305±90 ml）,specimen weight（42±31 g versus 45±33 g）and warm ischemia time（28±9.1 min versus 30± 9.2 min） were no significantly different（P〉0.05） between two groups,While in group A, Operative time（175± 55 rain versus 248± 70 min） , tolerating regular diet time（24± 5 h versus 49 ± 11 h） and the postoperative hospital stay（6.5±1.6 d versus 8.4± 1.9 d） were reduced than those of group B（P〈0.05）. Conclusions： Laparoscopic partial nephrectomy can he performed efficiently and effectively with the retroperitoneal and transperitoneal approach. While total operative time,tolerating regular diet time and the postoperative hospital stay may be quicker with retroperitoneal laparoscopic partial nephrectomy.