腹腔镜下不同手术入路治疗大体积肾癌的效果比较

Comparison of clinical outcomes of transperitoneal and retroperitoneal approach in laparoscopic nephrectomy for large renal tumors

目的探讨腹腔镜治疗大体积(直径>7 cm)肾癌的入路对手术效果的影响。方法回顾性分析于2002年1月至2012年6月间就诊并接受腹腔镜根治性肾切除手术治疗,术后病理诊断为肾癌,病理提示肿瘤最大直径>7 cm的患者。统计经腹腔入路和经腹膜后入路患者各项围手术期信息,并分组进行比较。结果共60例患者被纳入进行分析。两组患者在基本情况、肿瘤位置等方面并无差异。5例手术中转开放术式。对于经腹腔入路组和经腹膜后腔入路组,平均手术时间分别为(218.6±27.6)min和(169.0±65.5)min(P=0.003)。在术中出血量、并发症、输血情况及术后住院时间等方面无统计学差异。术后对肿瘤的病理特点及肿瘤分级、分期进行评价,经腹腔入路所切除的肾肿瘤分期更高。结论采用腹腔镜手术治疗大体积肾癌安全可行,对于有一定腹腔镜手术基础的医师,对于经过仔细挑选的患者选择经腹腔或经腹膜后入路均可,对于不同的患者应选用合适的手术方案。术后的远期生存情况仍需进一步随访。

Objective To report the clinical experience of laparoscopic surgery for large renal tumors （larger than 7 cm in diameter） and to compare the outcome of transperitoneal and retroperitoneal approach. Methods We collect and analyzed the data of patients with renal tumors who underwent laparoscopic radical nephrectomy from January 2002 to June 2012, with tumor size larger than 7 cm by pathology, and compared the peroperation outcomes between transperitoneal and retroperitoneal approach.Results We analyzed 60 patients from January 2002 to June 2012. Patients’ demographic data showed no significant differences in age, gender, BMI, preoperation sCr, ASA, tumor size and position. 5 were converted to open surgery during the procedure. Time of surgery were （218.6±27.6）min and （169.0±65.5）min （P=0.003）, for transperitoneal and retroperitoneal approach, respectively. No significant differences in blood loss, transfusion, complications, days of hospital stay postoperation were showed. Analysis of the pathologic features indicated that tumors with higher T stage were more likely resected with transperitoneal approach.Conclusion For large renal tumors, laparoscopic radical nephrectomy is safe; transperitoneal and retroperitoneal approaches for radical nephrectomy are safe and feasible. For experienced surgeons, transperitoneal and retroperitoneal approaches are all feasible and the surgery strategies should be made after fully evaluation of the patient and tumor features individually. Observation for long-term outcome is needed.