腹腔镜下T2大体积肾癌根治术

Laparoscopic radical nephrectomy for clinical stage T2 renal cell carcinoma patients

目的评价腹腔镜下T2大体积肾癌根治术的临床应用价值。方法回顾性分析30例T2大体积肾癌腹腔镜肾癌根治切除术（腔镜组）和同期36例开放肾癌根治术（开放组）患者的临床资料。①腔镜组平均年龄（58．0±8．5）岁。CT检查肿瘤直径平均（8．5±2．2）cm。肿瘤位于左肾17例，右肾13例；肾上极4例，中部10例，下极14例，肾门水平2例。经后腹膜途径22例，经腹腔途径8例；肿瘤分期均为T2M0N0。②开放组平均年龄（60．0±9．0）岁。CT检查肿瘤直径平均（8．8±2．1）cm。肿瘤位于左肾20例，右肾16例；肾上极9例，中部10例，下极11例，肾门水平6例。经腰部切口26例，经肋缘下腹腔途径10例。肿瘤分期均为T2.比较2组手术时间、术中出血、术后恢复及围手术期并发症。结果腔镜组手术时间、术中出血量、胃肠功能恢复时间、引流管留置时间、术后下床活动时间、住院天数分别为（176±33）min、（200±80）ml、（1．8±0．5）d、（3．0±1．0）d、（3．0土1．0）d、（6．0±3．0）d，开放组分别为（130±27）min、（380±185）ml、（3．8±0．6）d、（5．0±2．0）d、（5．0±2．0）d、（11．0±4．0）d，2组比较差异均有统计学意义（P〈0．01）。围手术期并发症腹腔镜组有出血3例、高碳酸血症3例、肠梗阻1例、肝脏损伤1例，开放手术组出血5例、肠梗阻2例、肝脏损伤1例、切口感染1例，腔镜组和开放组围手术期并发症发生率分别为26．7％和27．8Yoo，2组比较差异无统计学意义（P〉0．05）。腔镜组1例因肿瘤包绕。肾蒂血管，无法游离肾蒂血管，中转开放手术。平均随访（15±2）个月，腔镜组出现肿瘤肺转移2例。开放组出现肝转移2例，肺转移1例。未发生肿瘤切口和穿刺孔种植。结论腹腔镜下肾癌根治性切除术治疗T2大体积肾肿瘤手术安全可行。

Objective To report the experience and results in comparing laparoscopic radical nephrectomy （LRN） and open radical nephreetomy （ORN） in the treatment of clinical T2 stage renal cell carcinomas. Methods Between Feb. 2004 and Jul. 2007, 30 patients （12 females and 18 males with average age of 58.0±8.5 years, range 42-68 years） received LRN and 36 patients （16 females and 20 males with average age of 60. 0 ± 9. 0 years, range 52--70 years） received ORN. The average tumor sizes in the LRN and ORN groups were （8.5±2.2）cm （range 7--12 cm） and （8.8±2. 1）cm （range 7 14 cm） respectively. Renal cell carcinoma was histopatologically confirmed in all the patients of these 2 groups after surgery. Results The operative time in the ORN group （130±27 min） was significantly shorter than that in the LRN group （176±33 min）, P〈0.01. The estimated blood loss in the LRN group （200±_80 ml） was also significantly less than that in the ORN group （380±185 ml）, P〈0.01. Patients in LRN group experienced significantly earlier bowel function recovery （P〈0.01） and shorter duration of drainage （P〈0.01） than those in the ORN group after operation. No severe perioperative complications occurred in all patients. The follow-up range was 6 27 months （average 15±2 months）. During the follow-up, 2 patients in the LRN group developed lung metastasis. In the ORN group, 2 patients developed liver metastasis and 1 developed lung metastasis. Conclusion I.RN has the advantages of minimal invasiveness and rapid postoperative recovery comparable to those of ORN, and it might be an alternative treatment option for the clinical T2 stage renal cell carcinomas.