两种腹腔镜肾部分切除术治疗T_(1a)期肾癌的对比研究

A Comparative Evaluation of Laparoscopic Partial Nephrectomy for Renal Carcinoma T_(1a) by Two Approaches

目的:评价经腹腔入路与后腹腔入路两种途径腹腔镜肾部分切除术治疗T1a期肾癌的技术特点及临床效果。方法:回顾性比较分析35例经腹腔入路(A组)与33例后腹腔入路(B组)腹腔镜肾部分切除术治疗T1a期肾癌患者的临床资料,对两组肿瘤大小、标本重量、性别、年龄、手术时间、术中出血量、热缺血时间、术后肠功能恢复时间、术后住院天数、围手术期并发症等指标进行对比研究。两组共68例患者均获得随访,比较两种术式的肿瘤学效果。结果:两组在肿瘤大小、标本重量、性别、年龄、手术时间、术中出血量、热缺血时间、围手术期并发症发生率、术后无瘤生存率等方面均无明显差异(P>0.05);B组在术后肠功能恢复时间及术后住院天数小于A组(P<0.05)。结论:对于治疗T1a期肾癌,两种途径的腹腔镜手术效果相似。后腹腔入路腹腔镜肾部分切除术对肠道干扰少,可缩短术后肠功能恢复时间及术后住院天数。本中心采用"三步走"方法-剪刀剪除肿瘤、双极电凝止血、Hem-o-lok结扎夹辅助8字缝合,安全、高效、可靠。肌苷、甘露醇及利尿剂使用可减少缺血再灌注损伤,保护肾功能。

Objective： To compare the techniques and clinical effect of laparoscopic partial nephrectomy by retroperitoneal and transperitoneal approaches. Methods： 68 patients with small renal cell carcinoma underwent transperitoneal （35patients,group A）and retroperitoneal （33 patients,group B）laparoscopic partial nephrectomy. Tumor size,specimen weight,gender, age, operative time, blood loss,hot ischemia time,post-operative intestinal function recovery time, the post-operative hospital stay and peri-operative complications were compared between group A and group B, respectively. Two groups of a total of 68 patients were followed up and compared on two surgical oncology effect. Results： Tumor size, specimen weight, gender, age, specimen weight, operative time, blood loss, hot isehemia time,peri-operative complications and tumor free survival rate were not significantly different （P〉0.05） between two groups. In group B, the postoperative intestinal function recovery time and the postoperative hospital stay were reduced than those of group A （P〈0.05）. Concltmions： The result of laparoscopie treatment for patients with retroperltoneal or transperltoneal approach was similar. The advantage in the relropemoneal approach had little interference to the intestinal tract and the less postoperative intestinal function recovery tiane and postoperative hospital stay postoperatively. The centre u^ed the methed called ＂the three step＂-to cut off tumor with knife, finish hemostasis with bipolar electrocoagulation, suture with Hem-o-lok ligation clip in a double loop like ＂8＂, is safe, efficient and reliable. Inosine, mannitol and diuretic may reduce ischemia-reperfusion injury, and protect renal function.