后腹腔镜较开放性肾癌根治术的手术优势及预后分析

Analysis for the advantages and prognosis of retroperitoneal laparoscopic radical nephrectomy for renal carcinoma

目的探讨后腹腔镜肾癌根治术治疗肾癌的手术优势及远期预后。方法选取手术治疗的50例肾癌患者进行回顾性分析,根据手术方法分为腹腔镜组(后腹腔镜肾癌根治术)27例和传统组(传统开放手术治疗)23例,比较2组围手术期指标、随访结局。结果腹腔镜组患者出血量、住院时间、肛门排气时间、术后引流量、拔出引流管时间、镇痛剂使用率、下床活动时间均低于传统组,差异有统计学意义(P<0.05),2组手术时间比较差异无统计学意义(P>0.05);腹腔镜组并发症率为3.70%(1/27)低于传统组的26.09%(6/23)(P<0.05);腹腔镜组与传统组的随访时间、48个月内出现复发与转移率、48个月的生存率、随访期间失访率差异均无统计学意义(P>0.05);生存分析显示:腹腔镜组中位47.0个月、传统组46.0个月,2组患者生存时间比较差异无统计学意义(P>0.05)。结论后腹腔镜肾癌根治术治疗肾癌的手术效果与传统开腹手术没有差别,但具有手术创伤小、术后恢复快的优势。

Objective To explore the advantages of laparoscopic radical nephrectomy in treatment of renal cell carcinoma and its long-term prognosis.Methods A total of 50 patients with renal cell carcinoma who were treated in our hospital from April 2009 to May 2012 were enrolled in the study.According to different operation methods,these patients were divided into laparoscopy group(laparoscopic radical nephrectomy,n=27)and traditional treatment group(traditional open surgery,n=23).The perioperative indexes and the follow-up ending were observed and compared between two groups.Results The amount of bleeding,hospitalization duration,anal exhaust time,amount of postoperative drainage,time of pulling out the drainage tube,usage rate of analgesic,length of ambulation in laparoscopy group were superior to those in traditional treatment group(P<0.05),however,there was no significant difference in operation time between two groups(P>0.05).The incidence rate of complication in laparoseopy group was 3.70%(1/27),which was significantly lower than that[26.09%(6/23)]in traditional treatment group(P<0.05).There were no significant differences in follow-up time,the recurrence and metastasis rate within 48 months,the survival rate within 48 months,follow-up failure rate between laparoscopy group and traditional treatment group(P>0.05).The survival time in laparoscopy group was 47 months,which was 46 months in traditional treatment group,there was no significant difference in survical time between the two groups(P>0.05).Conclusion Retroperitoneal laparoscopic radical nephrectomy in treatment of renal cell carcinoma is not different from the traditional open surgery,but it has the advantages of less surgical trauma and quick recovery after operation.