OPN与LPN治疗肾肿瘤临床疗效对比分析

Comparative Study on the Clinical Efficacy and Safety of OPN and LPN Surgical Treatment of Renal Tumor

目的比较开放肾部分切除术(OPN)与腹腔镜肾部分切除术(LPN)治疗肾肿瘤的临床疗效和安全性。方法选择2013年5月至2015年2月在武装警察部队陕西省总队医院住院治疗的肾肿瘤患者276例作为研究对象,采用抽签法随机分为观察组和对照组,各138例。观察组患者行LPN,对照组患者行OPN。比较两种手术方法的手术时间、术中肾脏热缺血时间、术中出血量、术后胃肠功能恢复时间、术后住院时间、术后引流量、术后引流管留置时间,并对两组患者安全性进行比较。结果观察组术中肾脏热缺血时间显著长于对照组[(31±4)min比(18±3)min],术中出血量显著少于对照组[(90±17)m L比(140±29)m L],手术时间、术后胃肠功能恢复时间、术后住院时间显著短于对照组[(138±22)min比(176±36)min,(38±9)h比(62±16)h,(14±3)d比(22±4)d],差异有统计学意义(P<0.01);两组术后引流量、术后引流管留置时间比较差异无统计学意义(P>0.05)。手术前观察组和对照组血清肌酐数值分别为(71±9)μmol/L、(72±8)μmol/L,两组间比较差异无统计学意义(P>0.01);手术后观察组和对照组血清肌酐数值分别为(90±9)μmol/L、(88±9)μmol/L,均高于治疗前(P<0.01),手术后两组间比较差异无统计学意义(P>0.05)。两组经过手术治疗后均未出现术后大出血、尿瘘等重大并发症,观察组出现腹膜损伤9例,肾周少量血肿6例,并发症发生率为10.9%;对照组出现腹膜损伤8例,肾周少量血肿9例,术后切口感染1例,并发症发生率为13.0%,两组并发症发生率比较差异无统计学意义(P>0.05)。结论LPN治疗肾肿瘤临床疗效稳定,与OPN相比,具有恢复快、创伤小、疗效与OPN相当的优点,是目前治疗肾肿瘤较为理想和安全的方法,值得进一步推广研究。

Objective To compare clinical efficacy,safety of open partial nephrectomy （ OPN） and lap-aroscopic partial nephrectomy（ LPN） to treat renal tumor. Methods A total of 276 hospitalized patients with renal tumor in Shaanxi People′s Armed Police Corps Hospital from May 2013 to Feb. 2015 were included as the research objects, and randomly divided into observation group （ 138 cases ） and control group （ 138 cases） . The observation group was treated with LPN,while the control group was treated with OPN. The oper-ation time,intraoperative kidney warm ischemia time,intraoperative blood loss,postoperative gastrointestinal function recovery time, postoperative hospital stay, postoperative drainage quantity, postoperative drainage tube indwelling time,and patients′ safety of the two groups were compared. Results The operative time, intraoperative renal warm ischemia time of the observation group were longer than the control group [（31 ± 4） min vs （18 ±3） min],blood loss was significantly lower than control group [（90 ±17） mL vs （149 ± 29） mL],postoperative recovery of gastrointestinal function,postoperative hospital stay of the observation group were lower than the control group [（138 ±22） min vs （176 ±36） min,（38 ±9） h vs （62 ±16） h, （14±3）dvs（22±4）d],thedifferencewasstatisticallysignificant（P 〈0.01）;postoperativedrainage quantity,postoperative drainage tube indwelling time had no significant difference（P〉0. 05）. Preoperative serum creatinine values of the observation group and the control group were （ 71 ± 9 ） μmol/L, （ 72 ± 8 ）μmol/L,the difference was not statistically significant （P〉 0. 05）;postoperative serum creatinine values in the observation group and the control group were （90 ± 9） μmol/L,（88 ± 9） μmol/L,higher than before treatment （P〈0. 01）,the difference between the two groups after surgery was not statistically significant （P〉0. 05） There were no major complications such as postoperative bleeding,urinary fistula in both groups after surgery,there were 9 cases of peritoneal injury,6 cases of small amount of renal hematoma, the inci-dence of complications was 10. 9%;there were 8 cases of peritoneal injury,9 cases of of small amount of renal hematoma,1 case of postoperative incision infection,the complication rate was 13. 0%,the two groups had no statistical difference （P〉0. 05）. Conclusion The clinical curative effect LPN treatment of renal tumor is stable,which is featured with quick recovery,small trauma,similar curative effect to OPN,thus is an ideal and safe treatment of renal tumor,and is worth popularizing and further research.