大体积肾癌患者的微创手术入路方案分析

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

目的 探讨经腹腔和经腹膜后入路下腹腔镜治疗大体积肾脏恶性肿瘤的效果.方法 本院收治的行根治性手术切除术肾癌患者62例,根据手术入路的不同,分为观察组（40例,经腹膜后入路）和对照组（22例,经腹腔入路）.统计并记录两组手术时间、术中出血量、术中及术后并发症、是否输血及是否需入重症监护室（Intensive Care Unit,ICU）、术后住院时间、术后病理结果等.结果 观察组手术时间显著低于对照组（P＜0.05）,两组在术中出血量、输血例数、中转开放例数、术中并发症、术后并发症、术后住院日和入ICU例数比较无显著性差异（P＞0.05）.观察组包括透明细胞癌33例,乳头状肾细胞癌5例,嫌色细胞癌2例;对照组包括透明细胞癌19例,乳头状肾细胞癌3例.两组均未发现阳性手术切缘.T分期在对照组中更高,差异具有统计学意义（P＞0.05）.两组病灶转移率、平均生存期和进展生存期差异无统计学意义（P＞0.05）.结论 对于经验丰富的医师,腹腔镜手术治疗大体积肾癌（＞7 cm）是安全可行的,经腹腹腔镜和经后腹膜腹腔镜方式各有其优势,手术方式的选择应该建立在仔细评估病例具体情况的基础上。

Objectives To investigate the clinical outcomes of transperitoneal and retroperitoneal approach in laparoscopic nephrectomy for large renal tumors.Methods 62 cases undergoing eradication operation in our hospital were divided into observation group （40 cases,retroperitoneal approach） and control group （22 cases,transperitoneal approach）.The operation duration,bleeding volume,complication occurrence rate,ICU,being hospital time and hostaligical results were determined.Results The operation time of observation group was significantly lower than that of control group （P 〈 0.05）,while no significant difference was found in bleeding volume,complication occurrence rate,ICU,being hospital time （P 〉0.05）.There were 33 cases of clear-cell tumor,5 cases of papillary rental cell carcinoma and 2 cases of chromophobe rental cell carcinoma in observation group;19 cases of clcar cell tumor and 3 cases of papillary rental cell carcinoma in control group.No positive surgical margins were found.Control group showed higher T stage,with significant difference （P 〈 0.05）.There was no significant difference between occurrence rate,and average lifetime （P 〉 0.05）.Conclusions Laparoscopic nephrectomy was feasible to treat large renal tumors （〉 7 cm） for doctors with rich experience.Transperitoneal and retroperitoneal approach in laparoscopic nephrectomy showed different features and the approach choice should made on the basis of precise evaluation on specific situation.