后腹腔入路与经腹入路腹腔镜下肾癌根治术的临床疗效比较

Comparison of clinical efficacy between retroperitoneal and transperitoneal approaches for laparoscopic radical nephrectomy

目的比较后腹腔入路与经腹入路腹腔镜下肾癌根治术的临床效果。方法回顾性分析28例择期行腹腔镜下肾癌根治术患者临床资料,其中14例行后腹腔镜肾癌根治术(观察组),其余14例行经腹入路腹腔镜肾癌根治术(对照组)。术后均随访24个月,比较两组手术指标及预后情况。结果观察组手术时间、术中失血量及术后排气时间均少于对照组(P<0.05),而两组术后全身炎症反应综合征(SIRS)发生率、术后住院时间及并发症发生率比较,差异均无统计学意义(P>0.05)。随访24个月,对照组1例发生远处转移,其余患者均无复发或癌转移。结论经后腹腔入路腹腔镜肾癌根治术较经腹入路腹腔镜下肾癌根治术手术用时及术中出血量更少,术后肠道功能恢复时间更短,而两种方法的并发症发生率及预后差别不大。

ObjectiveTo compare the efficacy between retroperitoneal and transperitoneal approaches for laparoscopic radical nephrectomy. MethodsClinical data of 28 patients receiving selective laparoscopic radical nephrectomy were retrospectively analyzed. Fourteen patients underwent laparoscopic radical nephrectomy via retroperitoneal approach（observation group） and the other 14 patients via transperitoneal approach（control group）. Postoperative follow-up of 24 months was performed in both groups. ResultsThe operative duration, intraoperative blood loss and duration for postoperative exhausting in the observation group were shorter or less than those in the control group（all P〈0.05） .There were no significant differences in the the incident rate of systemic inflammatory response syndrome,postoperative hospital stay and incident rate of postoperative complications between the two groups（all P〉0.05）. During the 24-month follow-up, distal metastasis occurred in one case of the control group, and no recrudesce or metastasis was found in the other patients. ConclusionLaparoscopic nephrectomy via retroperitoneal approach can shorten the operative duration, decrease the intraoperative blood loss, and can achieve faster gastrointestinal recovery compared to transperitoneal approach. However, there was no obvious difference in the incidence of complications and outcome between the two approaches.