三维腹腔镜与标准腹腔镜下肾部分切除术的对比研究

A comparative study of 3D laparoscopic and standard laparoscopic partial nephrectomy

目的比较三维腹腔镜与标准腹腔镜下肾部分切除术的临床资料，探讨三维腹腔镜下肾部分切除术的安全性、可行性和优缺点。方法回顾性分析2012年1月-2015年3月收治的49例局限性肾肿瘤患者的临床资料，男31例、女18例，平均年龄为（55．5±12．5）岁，肿瘤位于左侧肾脏26例、右侧肾脏23例，手术人路为经腹腔途径16例、经后腹腔途径33例。根据手术方法将患者分为三维腹腔镜组（3D组，20例）和标准腹腔镜组（标准组，29例）。比较两组手术参与者的视觉满意度、操作适应度、头晕不适度、眼睛疲劳度评分。比较两组患者的手术时间、术中失血量、热缺血时间、术后肠道通气恢复时间、术后住院天数，以及两组术后1个月双侧肾脏肾小球滤过率（GFR）。结果两组手术均成功完成，无中转开放手术病例。3D组视觉满意度、操作适应度和总体满意度评分均显著高于标准组（P值均〈0．05），两组间头晕不适度和眼部疲劳度评分的差异均无统计学意义（P值均〉0．05）。两组间手术时间、术中失血量、术中热缺血时间、术后肠道通气恢复时间、术后住院天数和并发症发生率的差异均无统计学意义（P值均〉0．05）。两组术后随访4～41个月，无1例患者发生复发和转移。两组术后1个月患侧肾脏GFR均较术前显著降低（P值均〈0．05），健侧肾脏GFR均较术前显著升高（P值均〈0．05）；两组间患侧和健侧肾脏手术前后GFR差值的差异均无统计学意义（P值均〉0．05）。结论应用三维腹腔镜技术行肾部分切除手术安全、可行；与标准腹腔镜相比，三维腹腔镜技术在视觉上和精细操作上可能具有一定的优势。

Objective To compare the clinical outcomes and characteristics of 3D laparoscopy and standard laparoscopy for partial nephrectomy and to investigate the safety and feasibility of 3D laparoscopic partial nephrectomy. Methods A retrospective analysis was conducted in 49 inpatients with kidney tumor who were treated by laparoscopic partial nephrectomy from January 2012 to March 2015. There were 31 males and 18 females, with an average age of （55.5 -I- 12.5~） years. The left was involved in 26 cases and the right was involved in 23 cases. Surgeries were completed via intraperitoneal approach in 16 cases and via retroperitoneal approach in 33 cases. There were 20 cases using 3D laparoscopic system （3D group） and 29 cases using standard laparoscopic system （standard laparoscopic group）. Vision satisfaction, operative adaption, dizziness and eyestrain of surgeons were compared between two groups. Meanwhile, operative time, intraoperative blood loss, warm ischemia time, recovery ventilation time, postoperative hospital stay, and the glomerular filtration rate （GFR） value atonemonthafter surgery were compared between the two groups. Results All procedures were completed successfully. The scores of vision satisfaction, operative adaption and total adaption of the 3D group were significantly higher than those in the standard laparoscopic group （all P〈0.05）, but there were no significant differences in dizziness or eyestrain of surgeons between the two groups （both P〉0. 05）. Neither were the operation time, intraoperativeblood loss, warm ischemia time, recovery ventilation time, postoperative hospital stay or complications between two groups （all P〉0.05）. All patients were followed up for 4 - 41 months. No recurrence or metastasis was found. Compared with preoperative one, GFR of the involved kidney was significantly decreased at one month after surgery in all patients （both P〈0. 05）, while GFR of the contralateral kidney was significantly increased （both P〈0. 05）. There was no significant difference in preoperative or postoperative GFR difference between two groups （both P〉0.05）. Conclusion 3D partial nephrectomy is a safe, feasible and effective procedure. Compared to standard laparoscopic technique, 3D laparoscopic technique may have some advantages in the visual and exquisite operation.