后腹腔镜成人型多囊肾切除术初步经验探讨

Retroperitoneal laparoscopic nephrectomy for autosomal dominant polycystic kidney disease:a single centre experience

目的：探讨后腹腔镜多囊肾切除手术技术,并与开放手术的效果进行比较评估。方法：2009年8月-2015年4月,我中心10例多囊肾患者共12例次进行腹腔镜多囊肾切除术,纳入腹腔镜组。2004年1月-2009年8月,开放切除11例多囊肾纳入开放组。对两组患者临床资料、围手术期情况等进行统计比较。结果：腹腔镜组平均年龄58.6岁（50-67岁）,男8例,女2例。开放组年龄55.4岁（48-63岁）,男7例,女4例。所有患者均为终末期肾病进行血液透析或腹膜透析。两组在年龄、性别、BMI、肾脏最大径以及ASA评分、术前肌酐、术前血色素、透析方式、切除侧别,输血率、术后血色素等方面差异无统计学意义。2例手术中转开放。腹腔镜组手术时间更长（215.7min vs.167.0min,P=0.019）切除标本质量小（1 279.5g vs.1 812.7g,P=0.004）。腹腔镜组在出血量（265.0ml vs.403.6ml,P=0.016）、手术切口长度（11.4cm vs.34.5cm,P〈0.001）、恢复饮食的时间（1.8dvs.4.0d,P〈0.001）及住院时间（12.6dvs.16.5d,P=0.005）比开放组更具优势。两组术后病理示未合并肿瘤。腹腔镜组并发症的发生率略低（25.0%vs 36.4%,P=0.667）,但差异无统计学意义。结论：与开放手术向比,后腹腔镜多囊肾切除术具有出血少、切口小、恢复快的优点,并发症发生率不高,但手术时间略长。后腹腔镜多囊肾切除术是安全可行的。

Objective：To describe our experience of retroperitoneal laparoscopic nephrectomy for autosomal dominant polycystic kidney disease（ADPKD）and compare outcomes between laparoscopic technique and open nephrectomy.Method：From January 2004 to April 2015,21 patients with ADPKD who underwent nephrectomy were reviewed.Demographic data and perioperative data were collected in both retroperitoneal laparoscopic procedure and transperitoneal open procedure.The laparoscopic nephrectomy group was compared with the open group.Result：The patients in laparoscopic group included eight males and two females whose average age was 58.6（range,50-67）years old.Other patients in open surgery group included seven males and four females whose average age was 55.4（range,48-63）years old.All patients presented end-stage renal failure treated by haemodialysis or peritoneal dialysis.There was no significant difference in these variables including age,sex,ASA score,body mass index（BMI）,maximum size of the kidney on the CT scan,dialysis mode,preoperative hemoglobin level,serum creatinine level,transfusion and postoperive hemoglobin level between the laparoscopic group and open group.Patients undergoing laparoscopic nephrectomy were more likely to have less specimen weights（1279.5g versus1812.7g,P=0.004）and longer operative time（215.7min versus 167.0min,P =0.019）.Data of the laparoscopic group was superior to those of open surgery group in blood loss（265.0ml versus 403.6ml,P=0.016）,surgical incision length（11.4cm vs.34.5cm,P〈0.001）,diet recovery（1.8dvs.4.0d,P〈0.001）and hospital stay（12.6dvs.16.5d,P=0.005）.Although more transfusion and complications occurred in open group,there was no significant difference between the two groups.Conclusion：Our technique of laparoscopic nephrectomy for massively enlarged polycystic kidneys in ADPKD is safe and offers all the advantages of minimal access surgery,such as smaller incision,decreased estimated blood loss,excellent cosmesis and faster recovery.