经腹腹腔镜肾癌根治与经腰腹腔镜根治术临床对比研究

Clinical Comparison of Transabdominal Laparoscopic Radical Nephrectomy and Transbronchial Radical Resection

目的探讨经腹腹腔镜肾癌根治与经腰腹腔镜根治术的临床效果。方法方便选取2015年1月—2018年2月该院肾癌患者60例,按治疗方案分经腹组(n=30)、经腰组(n=30)。经腰组予以经腰腹腔镜根治术,经腹组予以经腹腹腔镜肾癌根治术。对比两组手术情况(手术时间、术中失血量、禁食时间、住院时间)、并发症发生率、随访1年观察预后情况。结果经腹组手术时间较经腰组长(t=2.295,P<0.05);经腹组术中失血量、禁食时间、住院时间与经腰组对比,差异无统计学意义(t1=0.398、t2=0.506、t3=0.299,P>0.05);经腹组并发症发生率6.67%(2/30)与经腰组3.33%(1/30)对比,差异无统计学意义(χ^2=0.000,P>0.05);随访1年,无脱落病例,均有效随访;均无病死病例,经腹组未出现远端转移,无复发,经腰组发生肺转移1例,为T2期患者,以确切概率法计算,经腹组转移率0.00%(0/30)与经腰组3.33%(1/30)对比,差异无统计学意义(P>0.05)。结论经腹腹腔镜根治术与经腰腹腔镜根治术治疗肾癌均能获得良好手术效果,经腰入路手术时间略短,经腹入路转移风险更易控制,临床可根据实际情况选择手术方案。

Objective To investigate the clinical effects of transabdominal laparoscopic radical nephrectomy and transbronchial radical resection.Methods Convenient selection 60 patients with renal cell carcinoma in the hospital from January 2015 to February 2018 were enrolled.According to the treatment plan,the abdominal group(n=30)and the lumbar group(n=30)were divided.The lumbar laparoscopic radical operation was performed in the lumbar group,and the abdominal laparoscopic radical nephrectomy was performed in the abdominal group.The operation status(surgery time,intraoperative blood loss,fasting time,hospitalization time),complication rate,and prognosis were observed at 1 year follow-up.Results The operation time of the abdominal group was longer than that of the lumbar group(t=2.295,P<0.05).There was no statistically significant difference in blood loss,fasting time,hospitalization time and the waist group during the transabdominal group(t1=0.398,t2=0.506,t3=0.299,P>0.05);the incidence of complications in the abdominal group was 6.67%(2/30)compared with 3.33%(1/30)in the lumbar group.There was no statistically significant difference(χ^2=0.000,P>0.05).Follow-up 1 year,no cases of shedding,all effective follow-up;no cases of death,no distal metastasis,no recurrence,1 case of lung metastasis through the lumbar group,T2 patients,calculated by exact probability method.There was no statistically significant difference between the transabdominal group transfer rate of 0.00%(0/30)and the transthoracic group of 3.33%(1/30)(P>0.05).Conclusion Transabdominal laparoscopic radical surgery and transbronchial radical resection for renal cell carcinoma can achieve good surgical results.The operation time of the lumbar approach is slightly shorter,and the risk of trans-abdominal approach is easier to control.The clinical plan can be selected according to the actual situation.