后腹腔镜下保留肾单位手术治疗较大肾错构瘤的疗效分析

Clinical effect of retroperitoneal laparoscopic nephron-sparing surgery in treatment of large renal angiomyolipoma

目的探讨后腹腔镜下保留肾单位手术(retroperitoneal laparoscopic nephron-sparing surgery,RLNSS)治疗较大(肿瘤最大径>6cm)肾错构瘤(renal angiomyolipoma,RAML)的临床效果。方法回顾性分析2007年8月至2015年2月我院收治的24例RAML(最大径均>6cm)的临床资料,根据患者意愿24例中10例行RLNSS,14例实施传统开放手术(open nephron-sparing surgery,ONSS)治疗,分析比较两种术式的手术时间、热缺血时间、肿瘤最大径、术中出血量以及患者术后肠道恢复时间、术后住院时间及并发症发生率等方面的差异。结果 RLNSS、ONSS两组手术用时、肿瘤最大径比较差异无统计学意义(P>0.05)。但热缺血时间[RLNSS vs ONSS:(27.8±3.4)vs(24.5±3.7)min];术中出血量[RLNSS vs ONSS:(242±49)vs(338±63)ml];术后患者平均肠道恢复时间[RLNSS vs ONSS:(2.1±0.6)vs(2.9±0.8)d]和术后住院天数[RLNSS vs ONSS:(9.2±1.0)vs(11.4±1.4)d]指标间差异均具有统计学意义(P<0.05)。两种术式在手术并发症方面的差异无统计学意义(P>0.05)。结论对于较大RAML,RLNSS仍然是一种安全可行且有效的治疗方式,与ONSS相比,RLNSS具有手术时间短、术中出血少、创伤小及恢复快等优势,在临床实际选择时还需根据患者的具体情况及术者自身的操作水平而定。

Objective To investigate the clinical effect of retroperitoneal laparoscopic nephronsparing surgery （RLNSS） in treatment of large （〉6 cm） renal angiomyolipoma （RAML）. Methods A retrospective review was performed on 10 patients with RAML who underwent RLNSS and 14 patients with RAML who underwent open nephron-sparing surgery （ONSS） between August 2007 and February 2015. The following parameters such as operative time, warm ischemia time, tumor size in the maximum diameter and blood loss were compared between two groups, and then recovery time of intestinal function after operation, hospitalization time in postoperative and surgical complications were analysed. Results There was no statistical difference in operative time and tumor size in the maximum diameter. The warm ischemia time of the RLNSS group was （27.8±3.4） rain, while the ONSS group was （24.5 ± 3.7）rain. The blood loss of RLNSS group and the ONSS group was （242±49）ml and （338±63）ml respectively. The recovery time of intestinal function was （2.1 ±0.6）d in RLNSS group and （2.9±0.8）d in ONSS group. The mean hospitalization time in postoperative was （9.2±1.0）d in RLNSS group and （11.4± 1.4）d in ONSS group. There was statistically significance between the groups for the above indicators （P〈0.05）. However, the surgical complications between two groups was not statistically significant （P〉0.05）, Conclusions RLNSS is still a kind of safe, feasible and effective operation for large RAML. The RLNSS for treatment of RAML is advantageous with respect to a shoter Operative time, less blood loss and trauma and quicker recovery. In addition, it＇s necessary to combine the patient conditions with the doctor own manipulation ability for the selection of the procedure.