腹膜后入路与腹腔入路腹腔镜手术治疗大体积肾癌的临床疗效分析

Clinical Analysis of Retroperitoneal and Abdominal Laparoscopic Surgery for Massive Renal Cell Carcinoma

目的:探讨大体积肾癌采用腹膜后入路与腹腔入路腹腔镜手术治疗的临床疗效。方法:选择2016年6月—2018年5月在郑州大学第二附属医院泌尿外科行腹腔镜手术的72例肿瘤直径>7cm的肾癌患者作为研究对象,将患者以随机数字表法分为观察组(n=36)和对照组(n=36),观察组患者经腹膜后入路进行腹腔镜手术,对照组患者经腹腔入路行腹腔镜手术,对比分析两组患者手术相关指标、应激反应情况、炎症反应情况及不良反应情况。结果:观察组患者手术出血量为(150.45±5.25)ml、手术时间为(112.86±3.46)min、胃肠功能恢复时间为(1.51±0.12)d、术后住院时间为(4.52±1.02)d,均少于对照组的(188.36±6.12)ml、(131.45±3.25)min、(2.23±0.15)d、(5.86±1.14)d,差异有统计学意义(P<0.05);两组患者手术前后中心静脉压、平均动脉压及心率差异无统计学意义(P>0.05);手术后1d,两组患者白细胞、C反应蛋白(CRP)及白细胞介素-6(IL-6)水平均高于手术前,但观察组低于对照组,两组间差异有统计学意义(P<0.05);观察组发生不良反应3例,发生率为8.3%,对照组发生4例,发生率为11.1%,差异无统计学意义(P>0.05)。结论:与经腹腔入路相比,经腹膜后入路腹腔镜手术治疗大体积肾癌疗效更佳,且对机体炎症反应影响较小。

Objective:To investigate the clinical efficacy of retroperitoneal and abdominal laparoscopic surgery for massive renal cell carcinoma.Methods:From June 2016 to May 2018,72 cases of renal cell carcinoma with diameter greater than 7 cm underwent laparoscopic surgery in urology department of the Second Affiliated Hospital of Zhengzhou University were selected as the study subjects.The patients were divided into observation group(n=36) and control group(n=36) by random number table method.The patients in the observation group underwent laparoscopic surgery via retroperitoneal approach, while those in the control group underwent laparoscopic surgery via peritoneal approach.The operation related indexes, stress reaction, inflammation reaction and adverse reactions of the two groups were compared and analyzed.Results:In the observation group,the operative blood loss was(150.45±5.25)ml,the operative time was(112.86±3.46)min,the gastrointestinal function recovery time was(1.51±0.12)d,and the postoperative hospitalization time was(4.52±1.02)d,Less than the control group(188.36±6.12)ml,(131.45±3.25)min,(2.23±0.15)d,(5.86±1.14)d,the difference was significant(P<0.05).There was no significant difference in central venous pressure, mean arterial pressure and heart rate between the two groups before and after operation(P>0.05).1 day after surgery,the levels of leukocyte,c-reactive protein(CRP) and interleukin-6(IL-6) in both groups were higher than those before surgery.But the observation group was lower than the control group.The difference was significant(P<0.05).There were 3 adverse reactions in the observation group(8.3%) and 4 in the control group(11.1%).There was no significant difference between the two groups(P>0.05).Conclusion:Compared with transperitoneal approach, retroperitoneal laparoscopic surgery is more effective in the treatment of large renal cell carcinoma,and has less effect on inflammatory reaction.