后腹腔镜下程序化肾癌根治术的围术期效果分析

Perioperative efficiency of patients treated by retroperitoneal laparoscopic procedural radical nephrectomy

目的比较后腹腔镜下程序化肾癌根治术与传统后腹腔镜手术的围术期效果。方法分析68例局限性肾癌患者的临床资料,其中31例行后腹腔镜下程序化肾癌根治术者为A组,37例行后腹腔镜下传统肾癌根治术者为B组。比较2组患者术中、术后相关参数,包括手术时间、术中估计出血量、肠道功能恢复时间、总引流量及术后住院时间等。结果 68例患者均顺利完成腔镜微创手术,无中转开放手术者及发生严重并发症者。A组手术时间、术中估计出血量、肠道功能恢复时间、术后总引流量及术后住院时间依次为(59. 2±8. 5) min、(109. 3±39. 9) m L、(2. 2±1. 2) d、(134. 0±40. 2) m L及(4. 1±1. 1) d,显著优于B组的(79. 1±13. 8) min、(231. 4±88. 7) m L、(3. 4±1. 3) d、(256. 1±80. 5) m L及(5. 9±1. 6) d (P <0. 05)。随访2～24个月,所有患者恢复良好,无肿瘤局部复发及转移等情况发生。结论后腹腔镜下程序化肾癌根治术具有手术步骤优化、后腹膜解剖层次清晰、手术时间短、操作难度低、出血少、术后快速康复等特点,早期效果满意。

Objective To compare the perioperative efficiency between retroperitoneal laparoscopic procedural radical nephrectomy and conventional laparoscopic surgery.Methods Clinical materials of 68 patients with localized renal cell carcinoma were analyzed.Among them,31 cases treated by retroperitoneal laparoscopic procedural radical nephrectomy were designed as group A,and 37 cases treated with conventional laparoscopic surgery were designed as group B.Relevant parameters during and after operation were compared between the two groups,including operation time,estimated bleeding volume during operation,recovery time of intestinal function,total drainage volume and hospital stay after operation.Results All the 68 patients successfully completed laparoscopic minimally invasive surgery,without cases conversed into open surgery or complicated with serious complications.The operation time,estimated bleeding volume during operation,recovery time of intestinal function,total drainage volume after operation and hospital stay after operation were(59.2±8.5)minutes,(109.3±39.9)mL,(2.2±1.2)days,(134.0±40.2)mL and(4.1±1.1)days respectively in group A,which were significantly better than(79.1±13.8)minutes,(231.4±88.7)mL,(3.4±1.3)days,(256.1±80.5)mL and(5.9±1.6)days in group B(P<0.05).After follow up for 2 to 24 months,all patients recovered well without local recurrence or metastasis.Conclusion Retroperitoneal laparoscopic procedural radical nephrectomy has the advantages such as optimizing surgical procedures,clear anatomical layers of the retroperitoneum,short operation time,low operation difficulty,less bleeding and quick recovery after operation,and the efficiency in early period is satisfactory.