后腹腔镜下肾癌根治术与开放性肾癌根治术治疗局限性肾癌的临床比较研究

Clinical comparative study of retroperitoneal laparoscopic radical nephrectomy and open radical nephrectomy for localized renal cell carcinoma

目的比较分析后腹腔镜下肾癌根治术与开放性肾癌根治术治疗局限性肾癌的手术效果。方法选择2010年1月-2013年1月我院行后腹腔镜下肾癌根治术患者30例作为腹腔镜组,同时选择同期行开放性肾癌根治术30例患者作为对照组,比较两组各项手术观察指标：包括手术时间、术中出血量、住院时间;同时对两组并发症情况进行比较分析。结果腹腔镜组患者术后无一例中转开腹手术,手术时间60-220 min,术中出血量20-180 m L。术后下床活动时间2-3 d,肠功能恢复时间1-4 d,住院时间6-13 d。术后随访3-24个月,未发现肿瘤复发或转移。腹腔镜组的手术时间长于对照组,差异有统计学意义（P〈0.05）。但腹腔镜组的术中出血量少于对照组,差异有统计学意义（P〈0.05）。腹腔镜组的住院时间短于对照组,差异有统计学意义（P〈0.05）。腹腔镜组无一例出现切口感染、深静脉血栓发生,腹腔镜组并发症发生率10%,对照组并发症发生率达30%,腹腔镜组并发症发生率显著低于对照组,差异有统计学意义（P〈0.05）。结论与开放性肾癌根治术比较,后腹腔镜下肾癌根治术治疗局限性肾癌具有出血少、并发症少等优势,值得推广和应用。

Objective To compare the effect of laparoscopic radical nephrectomy and open radical nephrectomy in treatment of localized renal cell carcinoma. Methods From January 2010 to January 2013 in our hospital, selected 30 patients as the laparoscopic group,and at the same time, selected 30 cases with open renal cell carcinoma radical operation as the control group, the surgical outcome measures were compared and analyzed between two groups, the operation time, intraoperative blood loss, hospitalization time and the complications were compared and analyzed between two groups. Results There was no conversion to open surgery, the operation time was 60-220 min, the amount of bleeding was 20-180 m L. The activity of the bed was 2-3 d, the recovery time of intestinal function was 1-4 d,the length of hospital stay was 6-13 d. The patients were followed up for 3-24 months,no tumor recurrence or metastasis was found. The operation time of the laparoscopic group was longer than that of the control group, the difference was statistically significant（P〈0.05）. But the amount of bleeding in laparoscopic group was less than that of the control group（P〈0.05）. The hospitalization time of the laparoscopic group was shorter than that of the control group（P〈0.05）. The laparoscopic group without a case of incision infection, deep vein thrombosis,the complications incidence in laparoscopic group was 10%,the complication rate of control group was 30%,the complication rate in the laparoscopic group was significantly lower than that of the control group（P〈0.05）. Conclusion Compared with open radical nephrectomy,retroperitoneal laparoscopic radical nephrectomy for renal carcinoma has the advantages of less bleeding, less complications, and is worthy of popularization and application.