肾癌后腹腔镜下肾部分切除术与开放性肾部分切除术的比较研究

Comparison of open and retroperitoneal laparoscopy partial nephrectomy on small renal carcinoma

目的分析后腹腔镜下肾部分切除术（RLPN）及开放性肾部分切除术（OPN）治疗肾癌的有效性及安全性。方法回顾性分析2006年2月至2009年8月我院收治的行肾部分切除术79例肾癌患者（肿瘤最大径≤4cm）,平均年龄53.9岁。79例患者分为RLPN组（42例）和OPN组（37例）,比较两组肾蒂阻断时间、手术时间、术中出血量、术中输血率、术后并发症、住院时间以及生存随访情况等。结果 RLPN组和OPN组肾蒂血管阻断时间、手术时间以及术后住院时间分别为（32.10±5.71）min和（23.10±4.68）min、（109.90±20.40）min和（120.30±17.52）min、（7.80±1.41）d和（9.10±1.79）d,两组比较差异均有统计学意义（P〈0.05）;术中出血量和术中输血率分别为（107.0±73.99）ml和（130.20±89.51）ml、2.4%（1/42）和2.7%（1/37）,两组比较差异无统计学意义（P〉0.05）;术后并发症分别为2.4%（1/42）和8.1%（3/37）,两组比较差异无统计学意义（P〉0.05）。两组术后随访18~60个月,无复发或转移,1年生存率为100%。结论对于较小的肾癌,RLPN术式的手术时间较短,术后患者恢复快,但受限于操作条件和技术,肾蒂阻断时间较长,值得在具备条件的医院推广。

Objective To compare the efficacy and safety on renal carcinoma with retroperitoneal laparoscopic partial nephrectomy（RLPN） and open partial nephrectomy（OPN）.Methods A total of 79 cases,suffering from renal carcinoma from February 2006 to August 2009 in our hospital were analyzed retrospectively.The maximal tumor diameter was within 4cm.The patients aged from 35 to 75 were divided into 2 groups： RLPN group with 42 cases and OPN group with 37 cases.The differences of renal pedical clamping time,operation time,blood loss,postoperative hospital stay and the incidence of complications between the two groups were compared and analyzed.Results The renal pedical clamping time,operation time,and hospitalization stay of RLPN and OPN group were（32.10±5.71）min and（23.10±4.68）min,（109.90±20.40）min and（120.30±17.52）min,and（7.80±1.41）d and（9.10±1.79）d respectively.There was statistical significance between the two groups.The blood loss and intraoperative blood transfusion rate of RLPN and OPN group were（107.0±73.99）ml and（130.20±89.51）ml,2.4%（1/42） and 2.7%（1/37）.There was no significant difference between them（P0.05）.The rates of postoperative complication in RLPN and OPN group were 2.4%（1/42） and 8.1%（3/37）,which was no significant difference between them（P0.05）.The follow-up of the two groups was 18-60 months without recurrence and metastasis.The 1-year survival rate was 100%.Conclusion As for small kidney cancer,RLPN has the advantage of shorter operating time and faster recovery.But RLPN has longer renal pedicle clamping time due to operating conditions and technology.RLPN is worthy of promotion for qualified hospital.