后腹腔镜肾癌根治性切除术与开放手术的疗效比较

Retroperitoneal laparoscopic nephrectomy and open nephrectomy for radical treatment of renal cell carcinoma: a comparison of clinical outcomes

目的：比较后腹腔镜肾癌根治性切除术与开放手术的临床疗效。方法：53例限期行肾肿瘤切除手术的患者分成2组，后腹腔镜组（n=27）和开放手术组（n=26）。对两组患者的手术时间、术中失血、止痛剂使用、术后禁食和住院时间等进行统计分析。并对患者长期随访，比较两组的生存率、切口愈合情况及转移情况。结杲：两组手术均获成功，后腹腔镜组和开放手术组患者性别构成、肿瘤临床分期、年龄和肿块大小程度具有可比性。后腹腔镜组平均手术时间为（66．66±10．37）min，开放手术组为（69．08±11．22）min，两组间无显著差异。后腹腔镜组住院时间（d）明显少于开放手术组（6．92±0．96 vs 11．42±1．57，P〈0．05）；开放手术组术后禁食时间（d）明显多于后腹腔镜组（2±0．68 vs 1±0．36，P〈0．05）；术中失血（m1）后腹腔镜组明显少于开放手术组（72．03±19．37 vs 154．4±20．42，P〈0．01）；后腹腔镜组术后2人次用止痛剂，开放手术组术后20人次应用哌替啶止痛，两组有显著差异（P〈0．01）；后腹腔镜组术后无切口感染，开放手术组术后1倒切口感染。随访6～12个月，两组均无肿瘤复发。结论：与传统的根治性肾癌切除术相比，后腹腔镜肾癌根治术具有手术时间短、出血少、住院时间短、康复快、并发症少等优点。

Objective：To compare the clinical outcomes of laparoscopic nephrectomy and open nephrectomy for radical treatment of renal cancer. Methods： Fifty-three patients with renal cell carcinoma （due to receive radical renal tumor resection） were randomly allocated into 2 groups： retroperitoneal laparocopic （RL） group （n=27） and open approach （OA） group （n = 26）. The operation time, hospital stay, use of painkiller, fasting period after operation, and blood loss during operation were analyzed and compared. All the cases were followed up for 6-12 months and the survival rates, wound healing, and carcinoma metastasis were recorded. Results： Patients in both groups were all successfully treated and their sexes, clinical stages, ages, and tumor sizes were all comparable. The operation time was similar in the 2 groups, with that of RL group being （66.66±10.37） rain and of OA group being （69.08±11.22） rain. The fasting period in RL group （[1±0. 362 d） was significantly shorter than that in the OA group （[2±0.68] d , P〈0.05）. The hospital stay in RL group （6.92±0.96） was significantly shorter than that in OA group （11.42± 1.57 , P%0.05）. The blood loss in RL group （E72. 03±19. 37] ml） was less than that in OA group （[154.4±20.42] ml,P〈0.01）. The use of painkiller was 2 person-times in the RL group and 20 person-times in the OA group （P〈0.01）. No post-operation infection was noticed in RL group and there was one case of infection in OA group during followup. Conclusion： Compared with traditional open radical nephrectomy, laparoscopic radical nephrectomy has the advantages of rapid recovery, less pain, less blood loss, and less complications, etc.