腹腔镜下保留肾单位手术与开放手术治疗肾肿瘤的疗效比较

Comparison of Nephron-sparing Surgery with Nephron-laparoscopic Surgery Versus Open Surgery for Renal Neoplasms

目的比较腹腔镜下保留肾单位手术(RLNSS)与开放手术(ONSS)治疗肾肿瘤(RT)的疗效。方法选取肾肿瘤患者90例,其中采用RLNSS治疗的45例患者为腔镜组,采用ONSS进行治疗的45例为开放组,记录并比较两组患者的手术时间、术中出血量、术中肾脏缺血阻断时间、住院天数、术后肠道功能恢复时间、术前及术后复查的肌酐水平、术后并发症发生情况。结果腔镜组和开放组患者在年龄、性别、肿瘤大小、肿瘤位置、TNM分期、术前肌酐等方面差异无统计学意义(P>0.05)。腔镜组良性肿瘤5例,恶性肿瘤40例;开放组良性肿瘤6例,恶性肿瘤39例,两组对比差异无统计学意义(P>0.05)。腔镜组平均手术时间(128.55±13.56)min,开放组为(127.86±10.41)min,两组对比差异无统计学意义(P>0.05)。腔镜组术中平均出血量为(200.86±20.45)ml,开放组为(362.20±29.42)ml,差异具有统计学意义(P<0.05)。腔镜组患者平均肾脏缺血阻断时间为(29.45±2.50)min,明显高于开放组的(19.95±2.64)min,差异具有统计学意义(P<0.05)。术后复查肌酐水平,两组比较差异无统计学意义(P>0.05)。腔镜组患者平均住院天数为(7.56±1.25)d,明显短于开放组的(10.50±1.56)d,差异具有统计学意义(P<0.05)。腔镜组术后肠道功能恢复时间为(1.10±0.80)d,明显短于开放组的(2.20±1.32)d。腔镜组患者胸膜损伤2例,开放组胸膜损伤5例,术中大出血8例,并发症发生率为28.89%,明显高于腔镜组的4.44%,差异具有统计学意义(P<0.05)。术后随访过程中,两组患者均未发现RT复发和转移。结论 RLNSS在肾肿瘤的治疗中有安全性高、术中出血量少、并发症发生率低等优点,术后无RT复发和转移,是一种比ONSS更加有效的治疗方法。

Objective To compare the efficacy of laparoscopic surgery （ RLNSS） and open surgery （ ONSS） in the treatment of renal tumor （ RT） .Methods A total of 90 cases of patients with renal tumors were divided into 2 groups each with 45 cases.Laparoscopic group was treated with RLNSS ,open group was treated by ONSS ,the operation time,intraoperative blood loss,intraoperative renal ischemia time , blocking hospital stay , postoperative intestinal function recovery time , preoperative and postoperative serum creatinine levels ,postoperative complications of the 2 groups were recorded and compared .Results There had no statistically significant difference between the 2 groups in age,gender,tumor size,tumor location,TNM staging,preopera-tive serum creatinine （P〉0.05）.Laparoscopic group had 5 cases of benign tumors,40 cases of malignant tumors;open group had 6 cases of benign tumors and 39 cases of malignant tumors,there had no significant difference between the 2 groups （P〉0.05）. The average operation time of laparoscopic group was （128.55＋13.56） min,the open group was （127.86＋10.41） min,there was no significant difference between the 2 groups （P 〉0.05）.In laparoscopic group,the average amount of bleeding was （200.86＋20.45） ml,the open group was（362.20＋29.42） ml,the difference was statistically significant （P〈0.05）.The av-erage kidney ischemia occlusion time in the observation group was （29.45＋2.50） min,which was significantly higher than that of open group,（19.95＋2.64） min,the difference was statistically significant （P〈0.05）.There was no significant difference be-tween the 2 groups （P〉0.05）.The average hospital stay in the observation group was （7.56＋1.25） d,which was significantly shorter than the open group,（10.50＋1.56） d,the difference was statistically significant （P〈0.05）.Laparoscopic group,post-operative intestinal function recovery time was （1.10＋0.80） d,which was significantly shorter than the open group ,（2.20＋1.32） d.2 cases in laparoscopic group had pleural injury ,5 cases of open group had pleural injury ,intraoperative hemorrhage was 8 cases,the complication rate was 28.89%,which was significantly higher than the laparoscopic group ,4.44%,the difference was＆amp;nbsp;statisti cally significant （P〈0.05）.No RT recurrence and metastasis were found in the 2 groups during the follow-up.Conclu-sion RLNSS has the advantages of high safety ,low blood loss and low complication rate in the treatment of renal tumor .It is a more effective method than ONSS for RT recurrence and metastasis .