后腹腔镜下肾部分切除术对局限性肾癌的疗效分析

The Efficacy of Retroperitoneal Laparoscopic Partial Nephrectomy for Localized Renal Cell Carcinoma

目的探讨后腹腔镜下肾部分切除术(RLPN)对局限性肾癌(LRCC)的疗效及安全性。方法对肿瘤直径>4 cm且≤7 cm的LRCC患者68例,均行肾部分切除术(PN),其中RLPN组34例,开放的肾部分切除术(OPN)组34例,对比分析两组的疗效。结果 68例LRCC患者PN术均顺利完成。RLPN组与OPN组LRCC患者性别、年龄、瘤体直径、病程、术前术后肌酐与GFR、引流量等比较,差异均无统计学意义(P均>0.05)。RLPN组手术耗时、血管阻断时间长于OPN组,差异具有统计学意义(P均<0.05);RLPN组输血病例少于OPN组(P均<0.05);RLPN组拔管时间、肠道恢复时间、术后住院时间均明显短于OPN组(P均<0.05)。RLPN组患者围术期无中转开放、输血病例,术后出现1例尿瘘;OPN组围术期有5例输血病例。结论 RLPN能达到与OPN治疗相近的治疗结果,即可保留肾单位又具有微创效果,改善患者预后,是治疗瘤体直径>4 cm且≤7 cm LRCC较为安全可靠的手术方式。

Objective To investigate the safety and effectiveness of retroperitoneal laparoscopic partial nephrectomy ( RLPN) for localized renal cell carcinoma ( LRCC) .Methods 68 cases of LRCC patients with tumor diameter >4 cm and ≤7 cm received partial nephrectomy .34 patients received open partial nephrectomy ( OPN group) and 34 patients received retroper-itoneal laparoscopic partial nephrectomy (RLPN group),the efficacy of the 2 groups were compared.Results PN surgery of the 68 LRCC patients were successfully conducted .Sex,age,tumor diameter,duration,preoperative and postoperative creatinine and GFR,drainage between the OPN group and the RLPN group had no statistically significant difference (P>0.05).Operation time and vessel occlusion time in the RLPN group were longer than those of the OPN group ,the difference was statistically significant (P<0.05).Blood transfusion cases in the RLPN group was fewer than that of the OPN group (P<0.05).Extubation time,in-testinal recovery time ,postoperative hospital stay time in the RLPN group were significantly shorter than those of the OPN group (all P<0.05).RLPN group had no transit cases and blood transfusion cases during perioperative period ,and had 1 case of urina-ry fistula after surgery;OPN group had 5 blood transfusion cases during perioperative period .Conclusion RLPN can achieve similar treatment effect as the OPN treatment ,yet RLPN has a minimally invasive nephron-sparing effect and improve the progno-sis of patients ,it is a relatively safe and reliable treatment for LRCC with tumor diameter >4 cm and ≤7 cm.