腹腔镜下与开放性根治性肾切除术的前瞻性随机对照研究

A randomized controlled trial of laparoscopic vs open radical nephrectomy for renal cancer

目的 比较腹腔镜下与开放性根治性肾切除术治疗肾癌的疗效.方法 2006年1月至2009年7月T1～T2肾癌患者62例,随机分为2组,每组31例.分别行腹腔镜下及开放性根治性肾切除术,比较2组住院时间、手术时间、切口长度、术中出血量、并发症、术后局部复发率、远处转移率及死亡率.取第一类误差α=0.05,第二类误差β=0.10,2种术式术后住院时间均值相差2 d,差异有统计学意义.结果 2组患者术后住院时间分别为（5.4±1.3）及（8.1±2.2）d,中位切口长度分别为8及15 cm,中位术中出血量分别为100及200 ml,差异均有统计学意义（P〈0.05）.2组手术时间、术后并发症发生率、淋巴结清扫数、局部复发率、远处转移率、死亡率比较差异均无统计学意义（P〉0.05）.结论 腹腔镜下根治性肾切除术较开放性根治性肾切除术手术创伤小、住院时间短.

Objective To compare the therapeutic outcomes between laparoscopic radical nephrectomy and open radical nephrectomy for renal cancer. Methods A prospective randomized controlled trial was performed in Fujian Provincial Tumor Hospital from January 2006 to July 2009. Sixty-two cases were randomly divided into 2 groups： laparoscopic radical nephrectomy and open radical nephrectomy. Primary outcome （post-operative hospital stay） and second outcome （estimated blood loss, operative time, incision length, post-operative complications, recurrence, metastasis and survival） were compared between 2 groups. Results Post-operative hospital stay was （5.4±1.3）d in laparoscopic group and （8. 1±2.2）d in open group （P〈0.05）. Median estimated blood loss was 100 ml in laparoscopic group and 200 ml in open group （P〈0.05）. There were no significant difference be tween teh 2 groups in operative time, post-operative complications, recurrence, metastasis and survival rates （P〉0.05）. Conclusion Laparoscopic nephrectomy could reduce hospital stay, which provides a minimally invasive approach for renal cancer.