经后腹腔途径与经腹腔途径腹腔镜下肾部分切除术治疗肾门肿瘤的疗效比较

Comparative study of the effect of laparoscopic hilar partial nephrectomy by retroperitoneal approach versus transperitoneal approach in the treatment of renal hilar tumors

目的探讨经后腹腔途径与经腹腔途径腹腔镜下肾部分切除术治疗肾门肿瘤的疗效。方法将80例肾门肿瘤患者按手术入路方式不同分为经腹腔入路组(43例)和经后腹腔入路组(37例),比较两组患者手术相关指标、肾功能[血清肌酐(Cr)、肾小球滤过率(GFR)]、炎性因子[白细胞(WBC)、血清C反应蛋白(CRP)]、免疫功能[CD4+、CD8+、CD4+/CD8+]指标。随访1年,比较两组并发症及复发转移情况。结果经后腹腔入路组患者手术时间、术后肠道功能恢复时间、住院时间均明显短于经腹腔入路组(P﹤0.05);经腹腔入路组患者WBC、CRP均高于经后腹腔入路组,CD4+、CD4+/CD8+均低于经后腹腔入路组(P﹤0.05);两组患者Cr、GFR、并发症及复发转移情况比较,差异均无统计学意义(P﹥0.05)。结论腹腔镜下经腹腔入路与经后腹腔入路肾部分切除术治疗肾门肿瘤患者均具有显著疗效,但相较于经腹腔入路,经后腹腔入路能够缩短手术时间,促进术后恢复进程,且具有免疫保护作用。

Objective To explore the efficacy of laparoscopic hilar partial nephrectomy through retroperitoneal approach or transperitoneal approach in the treatment of renal hilar tumors.Method This retrospective study included 80 patients with renal hilar tumors which were divided into transperitoneal approach group(n=43) and retroperitoneal approach group(n=37) by two different approaches employed in partial nephrectomy.The two groups of patients were compared for the related surgical measures,renal function [serum creatinine(Cr),glomerular filtration rate(GFR)],inflammatory factors [white blood cell(WBC),serum C-reactive protein(CRP)] and immune functions [CD4+,CD8+,CD4+/CD8+].The incidence of complications,recurrence and metastasis between the two groups after 1-year follow-up were also evaluated.Result The operative time,time to postoperative recovery of intestinal function and hospitalization time in retroperitoneal approach group were significantly shorter than those in the transperitoneal approach group(P<0.05);the WBC and CRP in transperitoneal approach group were significantly higher than those in retroperitoneal approach group,besides,the levels of CD4+ and CD4+/CD8+ in transperitoneal approach group were significantly lower compared to retroperitoneal approach group(P<0.05);meanwhile,no significant difference was noted in regard to the Cr,GFR and incidence of complications,recurrence and metastasis between the two groups(P>0.05).Conclusion The laparoscopic partial nephrectomy by transperitoneal approach and retroperitoneal approach have demonstrated significant effect in the treatment of patients with renal hilar tumor,while the retroperitoneal approach may shorten operative time,promote postoperative recovery,and exertsan immune protective effect compared to transperitoneal approach,.