经腹和经腹膜外入路在原发性腹膜后肾周脂肪肉瘤开放手术中的应用

Application of transabdominal and extraperitoneal approaches in open surgery for primary retroperitoneal liposarcoma arising from perirenal fat

目的 探讨经腹和经腹膜外入路在原发性腹膜后肾周脂肪肉瘤开放手术中的应用效果。方法 回顾性分析2015年12月-2022年10月收治的19例起源于肾周脂肪的原发性腹膜后脂肪肉瘤患者的临床资料,比较经腹和经腹膜外开放手术的手术时间、术中出血量、术后排气时间、术后拔管时间、术后住院时间、术后并发症以及术后无病生存期情况。采用SPSS 24.0软件进行统计分析,正态分布的计量资料用■±s表示,比较采用独立样本t检验;偏态分布的计量资料用M(Q1,Q3)表示,比较采用非参数秩和检验;计数资料比较采用χ2检验;采用Kaplan-Meier法检验进行生存分析。结果 经腹手术者和经腹膜外手术者的手术时间分别为(183.7±32.5)min和(263.7±80.7)min(t=-3.141、P=0.006),术中出血量分别为200(175,400)ml和650(450,1 375)ml(Z=-2.666、P=0.007),差异均有统计学意义(P均<0.01)。而两种手术入路患者的术后排气时间分别为4.0(3.0,6.5)d和5.0(2.8,7.0)d(Z=-0.045、P=0.996),术后拔管时间分别为(17.4±6.9)d和(16.7±8.5)d(t=0.197、P=0.846),术后住院时间分别为(21.0±7.7)d和(18.0±7.6)d(t=0.795、P=0.445),差异均无统计学意义(P均>0.05)。术后并发症,经腹入路4例、经腹膜外入路1例(χ2=0.421、P=0.516);两者中位无病生存期分别为24个月和16个月(χ2=2.872、P=0.09),差异均无统计学意义(P均>0.05)。结论 在原发性腹膜后肾周脂肪肉瘤开放手术中,经腹入路手术时间短、术中出血量少,优于经腹膜外入路。

Objective To investigate the application and effectiveness of transabdominal,transperitoneal extraperitoneal approaches in open surgery for primary retroperitoneal perirenal liposarcoma arising from perirenphric fat.Methods The clinical data of 19 patients diagnosed with primary retroperitoneal liposarcoma arising from perinephric fat in our hospital from December 2015 to October 2022 were retrospectively analyzed.The surgical time,intraoperative blood loss,postoperative exsufflation time,postoperative extubation time,postoperative hospitalization time,postoperative complications,and postoperative disease-free survival data were compared between the transabdominal and the extraperitoneal open surgery group.SPSS 24.0 software was used for statistical analysis.Normally distributed continuous data were expressed as ■±s,and comparison was performed by independent sample t-test.Measurement data with skewed distribution were described as M(Q1,Q3)and compared using the non-parametric rank sum test.Enumeration data were compared by χ^(2)-test.Kaplan-Meier method was used for survival analysis.Results The surgical time for transabdominal surgery and extraperitoneal surgery was(183.7±32.5)min and(263.7±80.7)min,respectively(t=-3.141,P=0.006).The intraoperative blood loss was 200(175,400)ml and 650(450,1375)ml,respectively(Z=-2.666,P=0.007).Both differences were statistically significant(all P<0.01).However,the postoperative exsufflation time of the two groups was 4.0(3.0,6.5)d and 5.0(2.8,7.0)d,respectively(Z=-0.045,P=0.996);postoperative extubation time was(17.4±6.9)d and(16.7±8.5)d,respectively(t=0.197,P=0.846);and the postoperative hospital stay was(21.0±7.7)d and(18.0±7.6)d,respectively(t=0.795,P=0.445).All differences were not statistically significant(all P>0.05).There were 4 cases of postoperative complications occurred in transabdominal approach group and 1 case in the extraperitoneal approach group(χ^(2)=0.421,P=0.516).The median number disease-free survival periods for both approaches of the two groups were 24 months and 16 months,respectively(χ2=2.872,P=0.09),and the differences were not statistically significant(all P>0.05).Conclusions In the open surgery for primary retroperitoneal perirenal liposarcoma arising from perinephric fat,the transabdominal approach has the advantages of shorter surgical time and less intraoperative blood loss compared to the extraperitoneal approach.