开腹和微创肾部分切除术对孤立肾肾癌的应用效果比较

Comparison of the Effects of Open and Minimally Invasive Partial Nephrectomy on Solitary Kidney Tumor

目的比较开腹和微创肾部分切除术(partial nephrectomy,PN)对孤立肾肾癌的应用效果。方法选取2012年1月至2016年8月我院收治的行PN治疗的49例孤立肾肾癌患者为研究对象,其中男38例,女11例,年龄38~80岁,平均(62.5±11.0)岁。根据手术方式分为常规腹腔镜组(n=15)、机器人腹腔镜组(n=11)和开放组(n=23),比较3组的基线资料和围手术期资料,对所有患者术后均进行定期的门诊随访,观察有无肿瘤复发及血清肌酐(serum creatinine,Scr)、肾小球滤过率估计值(glomerular filtration rate,GFR)、血红蛋白(hemoglobin,Hb)的变化。结果 3组的基线资料、手术时间、术中输血及并发症的发生率比较,差异无统计学意义(P>0.05)。全部患者均成功完成手术操作,3组的术中失血量、热缺血时间(warm ischemia time,WIT)和住院时间比较,差异均有统计学意义(P<0.05),具体而言,术中失血量:开放组>常规腹腔镜组>机器人腹腔镜组;WIT:常规腹腔镜组>机器人腹腔镜组、开放组;住院时间:开放组>常规腹腔镜组>机器人腹腔镜组。全部患者随访5~61个月,中位随访时间为23.5个月,期间共有3例(6.1%)发现局部复发,无一例远处转移者,无瘤生存时间为(22.3±15.5)个月。3组的局部复发率、手术前后的Scr、GFR、Hb比较,差异无统计学意义(P>0.05)。结论与传统开放和常规腹腔镜下PN手术相比,机器人腹腔镜手术具有术中出血量少、WIT短、术后恢复快的优点,更加有利于保护残肾功能,应用效果最佳。

Objective To investigate the effect of open and minimally invasive partial nephrectomy（ PN） on solitary kidney tumor. Methods 49 patients with solitary kidney tumor underwent PN from January 2012 to August 2016 were enrolled for the study and included 38 males and 11 females. Their average age was（ 62. 5 ± 11. 0） years,ranged from 38 to 80 years. All cases were divided into the routine laparoscopic group（ n = 15）,the robot-assisted laparoscopic group（ n = 11） and the open group（ n = 23）. The baseline data and perioperative data were compared among three groups. All patients were followed up regularly,observing the changes of serum creatinine（ Scr）,glomerular filtration rate estimation（ GFR） and hemoglobin（ Hb）.Results There were no significant differences in baseline data,operation time,rates of blood transfusion and complications among three groups（ P〈0. 05）. All patients successfully underwent operation,and there were significant differences in intraoperative blood loss,warm ischemia time（ WIT） and time of hospitalization among three groups（ P〈0. 05）. Specifically,the order of intraoperative blood loss,WIT and time of hospitalization was that the open group the routine laparoscopic group the robot-assisted laparoscopic group; the routine laparoscopic group the robot-assisted laparoscopic group and the open group; the open group the laparoscopic group the robot-assisted laparoscopic group. All patients were followed up for 5 ～ 61 months whose median follow-up time was 23. 5 months. A total of 3 cases（ 6. 1%） were found with local recurrence,no one with metastasis,and tumor free survival time was（ 22. 3 ± 15. 5） months. There were no significant differences in the local recurrence rate,Scr,GFR and Hb before and after operation among three groups（ P〈0. 05）. Conclusions Compared with traditional open and routine laparoscopic PN,robot-assisted laparoscopic surgery has the advantages of less intraoperative bleeding,shorter WIT and faster postoperative recovery,which is helpful to protect the residual renal function and has the best effect.