内视镜下小切口根治性肾癌切除术临床研究

Clinical study of 108 cases performed radical nephrectomy by video-assisted minilaparotomy

目的比较内视镜下小切口根治性肾癌切除术与开放手术方法的应用价值。方法行内视镜下小切口根治性肾癌切除术(A组)108例,左肾60例,右肾48例;临床分期:T1N0M017例,T2N0M083例,T3aN0M08例。同期行开放性肾癌根治性切除(B组)45例,左肾25例,右肾20例;临床分期:T1N0M03例,T2N0M035例,T3aN0M07例。2组手术均由同一组医师完成。比较2种方法的手术时间、术中失血量、术后肠功能恢复时间、引流管留置时间、下床活动时间及术后平均住院时间。结果A组发生手术并发症2例。A组手术时间为(128±16)min,术中失血量(100±66)ml、术后肠功能恢复时间(0.9±0.5)d、引流管留置时间(0.8±0.6)d、下床活动时间(1.0±0.5)d及术后平均住院时间为(6.9±1.5)d。B组上述指标分别为(132±21)min、(220±86)ml、(2.4±1.5)d、(2.3±0.6)d、(4.0±1.8)d及(10.2±2.4)d。2组手术时间比较差异无统计学意义(P>0.05),但A组术中失血量、术后肠功能恢复时间、引流管留置时间、下床活动时间及术后平均住院时间明显优于B组(P<0.01)。结论与开放手术相比,内视镜下小切口根治性肾癌切除术具有创伤小、出血少、恢复快的优点,尤其在处理与周围组织粘连较重的肾癌时,与开放手术没有明显的区别。内视镜下小切口根治性肾癌切除术是一种安全、可靠、经济的手术方法。

Objective To investigate the advantages of video-assisted minilaparotomy radical nephreetomy for patients with renal neoplasm, and to compare the clinical outcomes and operative techniques of video-assisted nephrectomy with those of open stwgery. Methods 108 cases of renal neoplasm were performed video-assisted minilaparotomy nephrectomy （group A; 73 males and 35 females; mean age of 50 years, range 26 - 84 years）, in which 60 cases had the lesion on the left kidney and 48 cases on the right. Clinical stage： 17 cases were of stage T1N0M0 ,83 of T2N0M0 and 8 of T3aN0M0. At the same period,open nephrectomy was performed on another 45 cases of renal neoplasm （group B; 31 males and 14 females; mean age of 47 years,range 32 - 71 years） ;in which 25 cases had the lesionon the left, and 20 cases on the right. Preoperatively, 3 cases had the tumors of clinical stage T1 N0 M0,35 of T2 No Mo and 7 of T3aN0M0. The two kinds of operations were performed by the same team of surgeons. The operative time, intraoperative blood loss volume, intestinal function recovery time, indwelling drainage tube, ambulation and hospitolizatlon stay after operation were compared between the two groups. Results In group A complications occurred in 2 cases, of whom only 1 case required conversion to open surgery due to injury of genital gland vein, with blood loss of 800 ml. There was no significant difference between group A and group B regarding to the patients＇ age and mean operative time [ （128 ± 16）lnin vs （132± 21）min]. The mean blood loss, intestinal function recovery time, indwelling drainage tube, in-bed time and hospitolization stay of groups A and B were （ 100 ± 66） ml vs （220 ± 87 ） ml, （0.9 ± 0.5） d vs （2.4 ± 1.5） d, （0.8 ± 0.6） dvs （2.3±0.6） d, （1.0±0.5） dvs （4.0± 1.8） d, （6.9±1.5） dvs （10.2±2.4） d respectively. Conclusion Video-assisted minilaparotomy radical nephrectomy has several advantages compared with the open nephrectomy for patients with renal neoplasm, such as less trauma, less loss of blood, quicker recovery and so on, and there is no significant difference between two operative modalities when handle the carcinoma that has severe adhesion with its surrounding tissues. Therefore, video-assisted nephrectomy is safe, effective and economic.