腹腔镜与开放性肾部分切除术治疗T_(1a)期肾肿瘤的疗效比较

Comparison between laparoscopic and open nephron-sparing surgery for patients with T_(1a) renal tumors

目的:比较腹腔镜下肾部分切除术(LPN)与开放性肾部分切除术(OPN)治疗T_(1a)期肾肿瘤的疗效。方法:回顾性分析2010年10月～2017年12月我院收治的72例保留肾单位手术(NSS)患者的临床资料,其中行LPN 38例(LPN组),行OPN 34例(OPN组)。比较两组病例的手术时间、肾脏热缺血时间、术中出血量、术区引流管留置时间、手术切口长度、术后住院时间及患肾肾小球滤过率(GFR)变化,以及术后随访6～36个月有无肿瘤复发情况。结果:LPN组与OPN组患者术后引流管留置时间和患肾GFR值比较差异无统计学意义(P>0.05)。LPN组在术中出血量、手术切口长度及术后住院时间等方面均优于OPN组(P<0.05),而术中肾脏热缺血时间长于OPN组(P<0.05)。术后随访6～36个月,未见局部复发,均无转移。结论:尽管LPN术中肾缺血时间稍长,但与OPN相比,LPN治疗早期局限性肾肿瘤具有手术创伤小、恢复快、更微创,是一种更好的治疗T_(1a)期肾肿瘤的手术方法,值得进一步推广。

Objective:To compare the treatment of local renal tumor between laparoscopic nephron-sparing surgery(NSS)and open NSS.Method:A retrospective analysis of 72 clinical cases from October 2010 to December 2017 including laparoscopic partial nephrectomy(LPN)patients(n=38)and open partial nephrectomy(OPN)patients(n=34)was operated.The comparison between LPN and OPN was made in clinical indexes including operation time,warm ischemic time,blood loss,indwelling time of drainage tube,the length of the incision,postoperative hospital stay,postoperative glomerular filtration rate(GFR)change and postoperative recurrence after follow-up period of 6-36 months.Result:There was no significant difference in indwelling time of drainage tube or postoperative GFR between LPN group and OPN group(P>0.05).The LPN group was superior to the OPN group in blood loss,the length of the incision and postoperative hospital stay(P<0.05).The LPN group was longer than the OPN group in warm ischemic time(P<0.05).During the postoperative follow-up period of 6-36 months,no local recurrence or metastasis was found.Conclusion:Compared with the OPN group,the LPN group in renal ischemia time was slightly longer,but LPN is more minimally invasive with little trauma,quick recovery and shorter operative time.LPN can be a better way to treat local renal tumor.