经腹腹腔镜和后腹腔镜与开放性肾癌根治手术的疗效比较

Comparative study among transperitoneal and retroperitoneal nephrectomy as well as open nephrectomy

目的:评价经腹腹腔镜和后腹腔镜肾切除手术与开放肾根治性切除术的临床价值。方法:回顾分析我院自2011年11月~2014年4月病例资料,对32例经腹腹腔镜肾切除术、115例后腹腔镜肾切除手术和43例开放肾切除手术的临床资料进行比较,统计分析三种术式在手术操作时间、术中平均出血量、输血例数、腹腔引流管留置时间、术后住院时间和术后并发症等方面的差异。结果:经腹腹腔镜肾根治性切除术32例因术中大出血转开放手术2例,其余30全部成功;后腹腔镜手术115例除1例因后腹腔广泛粘连改开放手术外,其余114例成功;43例开放手术均获成功。三组手术时间分别为(153.5±47.4)min、(135.5±34.2)min和(121.8±30.3)min,经腹腹腔镜组和后腹腔镜组手术时间差异无统计学意义,两组手术时间均高于开放手术组(P=0.007,P=0.049)。三组术中出血量分别为(102.7±38.1)ml、(125.1±53.5)ml和(190±79.3)ml,三组比较差异均有统计学意义,经腹腹腔镜组术中出血低于后腹腔镜组(P=0.033),并显著低于开放手术组(P<0.001),后腹腔镜组术中出血显著低于开放手术组(P<0.001)。输血例数分别为7例、11例和5例,三组比较差异无统计学意义(P=0.13)。腹腔引流管留置时间分别为(6.5±2.9)d、(5.3±2.6)d和(5.7±1.5)d,三组比较差异无统计学意义(P=0.053)。三组术后住院时间分别为(10.5±4.1)d、(10.2±3.8)d和(12.6±3.1)d,经腹腹腔镜组和后腹腔镜组术后住院时间明显低于开放手术组(P=0.017,P<0.001)。经腹腹腔镜组术中无并发症,后腹腔镜组术中出现皮下气肿2例;开放手术组术中未发生并发症,术后1例因伤口感染愈合不佳。结论:经腹腹腔镜和后腹腔镜肾切除术在术中出血量和术后恢复等方面明显优于开放手术,开放手术所需时间较经腹腹腔镜和后腹腔镜肾切除术明显缩短,后腹腔入路虽技术难度较大,但手术效果优于经腹入路。

Objective： To assess the efficiency and safety of transperitoneal and retroperitoneal laparoscopic ne- phrectomy as well as open nephrectomy. Method： The clinical data of 32 patients receiving transperitoneal ne- phrectomy, 115 patients receiveing retroperitoneal laparoscopic radical nephrectomy and 43 patients receiving open radical nephrectomy from November 2011 to April 2014 were retrospectively analyzed. The operation time, blood loss, transfusion rate, time of indwelling drainage tube, postoperative hospital stay and postoperative complication of the three groups were compared. Result： In transperitoneal group, two patients converted to open radical ne phrectomy because of hemorrhage, and the other 30 patientg operations were successfully completed. One patient of the retroperitoneal nephrectomy group converted to open radical nephrectomy because of abdominal extensive adhesion, and the other 114 patients＇ operations were successfully completed. All open nephrectomies were suc- cessful. Three groupg operation time were （153.5±47.4） min, （135.5±34.2） min and （121.8±30.3） rain re- spectively. Blood loss were（102.7±38. 1） ml, （125. 1±53.5） ml and （190±79.3） ml respectively. The number of transfusion in three group were 7, 11 and 5. Time of indwelling drainage tube were （6.5±2.9） days, （5.3± 2.6） days and （5.7±1.5） days. Postoperative hospital stay were （10.5±4.1） days, （10.2±3.8） days and （12.6±3.1） days. In transperitoneal group, no complication oecured during surgery. Two patients in retroperito- neal group suffered from subcutaneous emphysema. No special complication happened during open surgery, except that one patient＇s incision delayed union because of infection. Conclusion： Transperitoneal and retroperitoneal ne- phrectomy is notably better than open surgery in aspects of blood loss during operation and postoperative recovery.The time need of open surgery is significantly shorter than that of transperitoneal and retroperitoneal nephrecto- my. In spite of technical difficulties, retroperitoneal nephrectomy is superior to transperitoneal nephrectomy.