探讨基于联合解剖标志、层面及腹膜返折悬吊术的程序化六步法后腹腔镜下肾癌根治术治疗局限性肾癌的临床效果

Clinical effect of programmatic six-step method for the retroperitoneal laparoscopic radical nephrectomy based on combined anatomical landmarks,trans-inaterfascial plane and peritoneal reflection suspension surgery in the treatment of localized renal cancer

目的探讨基于联合解剖标志、层面及腹膜返折悬吊术的程序化六步法后腹腔镜下肾癌根治术治疗局限性肾癌的临床应用价值。方法40例局限性肾癌患者作为研究对象,按照随机数字表法将患者分为对照组和试验组,每组20例。对照组采用传统开放肾癌根治术治疗,试验组采用基于联合解剖标志、层面及腹膜返折悬吊术的程序化六步法后腹腔镜下肾癌根治术治疗。比较两组患者的临床观察指标、输血率、并发症发生率,观察两组患者的术后随访结果。结果试验组患者的术中出血量(45.50±21.87)ml少于对照组的(89.00±38.09)ml,手术时间(109.95±19.17)min、术后下床活动时间(19.65±4.91)h、术后肠道功能恢复时间(23.35±6.69)h、术后引流管拔除时间(2.45±0.51)d、术后住院时间(5.45±0.99)d均短于对照组的(132.45±19.34)min、(33.85±6.99)h、(40.60±8.31)h、(5.05±1.05)d、(7.15±1.46)d,术后视觉模拟评分法(VAS)评分(4.10±1.33)分低于对照组的(7.80±1.36)分,差异有统计学意义(P<0.05)。两组患者的输血率、术后并发症发生率比较,差异无统计学意义(P>0.05);试验组患者的术中并发症发生率5%低于对照组的40%,差异有统计学意义(P<0.05)。术后随访9个月,无失访患者。两组患者均未发现有局部复发和远处转移者。结论采用基于联合解剖标志、层面及腹膜返折悬吊术的程序化六步法后腹腔镜下肾癌根治术作为局限性肾癌的手术治疗方法是安全有效的,术中严格执行程序化手术操作,循序渐进,手术有条不紊,术中能建立良好的手术操作暴露视野、外科层面解剖清晰,早期快速定位及阻断肾蒂血管及分支、变异血管,减少术中并发症的发生,缩短手术时间,患者术后恢复快、疼痛轻,未出现局部复发及远处转移的病例,能让患者受益,值得临床推广。

Objective To discuss the clinical value of programmatic six-step method for the retroperitoneal laparoscopic radical nephrectomy based on combined anatomical landmarks,trans-inaterfascial plane and peritoneal reflection suspension surgery in the treatment of localized renal cancer.Methods A total of 40 patients with localized renal cancer were studied and divided into a control group and an experimental group according to the random numerical table,with 20 patients in each group.The control group was treated with conventional open radical nephrectomy,and the experimental group was treated with programmatic sixstep method for the retroperitoneal laparoscopic radical nephrectomy based on combined anatomical landmarks,trans-inaterfascial plane and peritoneal reflection suspension surgery in the treatment of localized renal cancer.The clinical observation indexes,blood transfusion rate,and complication rate of the two groups were compared,and the postoperative follow-up results of the two groups were observed.Results The intraoperative blood loss(45.50±21.87)ml in the experimental group was less than(89.00±38.09)ml in the control group;in the experimental group,the operative time was(109.95±19.17)min,postoperative ambulation time was(19.65±4.91)h,postoperative bowel function recovery time was(23.35±6.69)h,postoperative drainage tube removal time was(2.45±0.51)d,and postoperative hospitalization time was(5.45±0.99)d,which were shorter than(132.45±19.34)min,(33.85±6.99)h,(40.60±8.31)h,(5.05±1.05)d,and(7.15±1.46)d in the control group;the postoperative visual analogue scale(VAS)score(4.10±1.33)points in the experimental group was lower than(7.80±1.36)points in the control group;the differences were statistically significant(P<0.05).There was no statistically significant difference in blood transfusion rate and incidence of postoperative complications between the two groups(P>0.05).The incidence of intraoperative complications in the experimental group was 5%,which was lower than 40%in the control group,and the difference was statistically significant(P<0.05).No patients were lost to follow-up,and no local recurrence and distant metastasis were found in the two groups of patients.Conclusion It is safe and effective to use a programmatic six-step method for the retroperitoneal laparoscopic radical nephrectomy based on combined anatomical landmarks,trans-inaterfascial plane and peritoneal reflection suspension surgery as a surgical treatment for localized renal cancer.During the operation,they strictly implement procedural surgical operations during the operation,step by step,and the operation is orderly.During the operation,a good surgical exposure field of view can be established,the anatomy at the surgical level is clear,and the renal pedicle blood vessels,branches and variant blood vessels can be quickly located and blocked in the early stage,and intraoperative complications can be reduced.It can shorten the operation time,the patients recover quickly after operation,the pain is mild,and there are no cases of local recurrence and distant metastasis,which can benefit the patients and is worthy of clinical promotion.