常规腹腔镜与3D腹腔镜在肾癌切除术中的临床应用比较

Comparison on clinical application of two kinds of laparoscopic nephron sparing surgery for renal carcinoma

目的:探讨常规腹腔镜与3D腹腔镜保留肾单位肾癌切除术的相关手术指标、炎性应激反应及对术后并发症的影响。方法:选取2015年3月至2017年3月收治的100例行保留肾单位肾癌切除术的患者,以随机数字表法分为对照组(n=50)与观察组(n=50),分别采用常规腹腔镜与3D腹腔镜手术。对比分析两组手术时间、术中热缺血时间、术中出血量、术后胃肠蠕动恢复时间、术后拔除引流管时间、住院时间、手术前后炎性应激反应水平及术后并发症发生率。结果:观察组手术时间、术中热缺血时间及术中出血量均显著优于对照组(P<0.05);两组患者术后胃肠蠕动恢复时间、术后拔除引流管时间、住院时间、术后并发症发生率差异无统计学意义(P>0.05);观察组术后炎性应激指标水平均显著低于对照组(P<0.05)。结论:与常规腹腔镜手术相比,3D腹腔镜保留肾单位肾癌切除术可有效缩短手术时间,减少术中医源性创伤,降低炎性应激反应水平,安全性值得认可。

Objective： To investigate the influence of conventional and 3D laparoscopic nephron sparing surgery for renal carcinoma on surgical related clinical indicators,inflammatory stress response and postoperative complications. Methods： One hundred patients undergoing nephron sparing surgery for renal carcinoma were chosen from Mar. 2015 to Mar. 2017 and randomly divided into two groups. 50 patients in control group received conventional laparoscopic scheme and 50 patients in observation group received 3D laparoscopic scheme. Operating time,intraoperative warm ischemia time,intraoperative bleeding volume,postoperative gastrointestinal peristalsis recovery time,postoperative drainage time,hospitalization time,perioperative inflammatory response and incidence of postoperative complications of both groups were compared. Results： Operating time,intraoperative warm ischemia time and intraoperative bleeding volume of observation group were significantly better than those of control group（ P〈0. 05）. There were no significant differences on postoperative gastrointestinal peristalsis recovery time,postoperative drainage time,hospitalization time and incidence of postoperative complications between 2 groups（ P〉0. 05）. The levels of inflammatory response after operation of observation group were significantly lower than those of control group（ P〈0. 05）. Conclusions： Compared with conventional laparoscopic scheme,3D laparoscopic nephron sparing surgery for renal carcinoma can efficiently shorten the operation time,reduce the iatrogenic trauma and the levels of inflammatory stress reaction,and its safety is worthy of recognition.