小肾癌手助腹腔镜和开放肾部分切除术的临床效果比较

Comparison of clinical effects between hand-assisted laparoscopic partial nephrectomy and open partial nephrectomy

目的比较小肾癌手助腹腔镜和开放肾部分切除术的临床效果。方法回顾分析30例行手助腹腔镜肾部分切除术和20例行开放肾部分切除术患者的病例资料,比较两种手术方法的失血量、手术时间、热缺血时间、切缘阳性率、患者住院时间、并发症及手术效果的差异。结果手助腹腔镜组和开放手术组平均肿瘤大小分别为(2.58±0.50)和(2.62±0.60)cm(P>0.05),平均出血量分别为(120.2±38.9)和(353.6±89.6)ml(P<0.01),平均手术时间分别为(158.2±27.6)和(196.2±39.6)min(P<0.05),平均热缺血时间分别为(26.1±3.2)和(35.2±2.8)min(P<0.05),平均住院时间分别为(7.8±2.0)和(12.3±3.0)d(P<0.01),两组的切缘阳性率、并发症发生率均无差异。随访3～28个月,两组均未出现局部复发。结论手助腹腔镜肾部分切除术较开放肾部分切除术手术时间短,出血少,住院时间短,且不增加热缺血时间,手术效果相当。

Objective To compare the clinical effects of hand-assisted laparoscopic partial nephrectomy （HALPN） and open partial nephrectomy （OPN）. Methods We retrospectively analysed the records of all patients who underwent partial nephrectomy in our hospital from February 2002 to October 2008, identifying 30 who had HALPN and 20 who had OPN. Variable analysis included operative time, blood loss,length of stay, warm ischemia time, positive margin rate ,complications, operation effect. Groups were compared using Student＇s t-test, and a probability （P） value of less than 0.05 was taken to indicate statistical significance. Results The respective mean tumor size was （2.58±0.50） and （2.62±0.60）cm（P〉0.05） in the HALPN and OPN group, the mean estimated blood loss was （120. 2±38.9） and （353.6±89.6）ml（P〈0.01）, the respective mean operative duration was（158.2 ± 27.6） and （196.2 ± 39.6） min（P〈0.05）, the mean warm ischemia time was （26.1±3.2） and （35.2±2.8）min（P〈0.05）, length of hospital stay was （7.8±2.0） and （12.3 ±3.0）days（P〈0.01）, complications and positive margin rate were similar in both groups. During the follow up period range from 3-28 months, none had local recurrence. Conclusions hand-assisted laparoscopic partial nephrectomy has a clear visual field, and has a shorter operation time, less blood loss, shorter length of hospital stay than open partial nephrectomy. It don＇t extend warm ischemia and operation effect of the two methods are similar.