经腹腔与后腹膜入路行腹腔镜根治性肾切除术的临床疗效比较

Comparison of clinical effects of laparoscopic radical nephrectomy through transperitoneal and retroperitoneal approaches

目的探讨经腹腔和经后腹膜途径行腹腔镜根治性肾切除术的临床效果和安全性。方法回顾性分析2007年3月至2017年9月于本院接受腹腔镜根治性肾切除术的56例患者的临床资料,按照手术入路方式不同将其分为经腹腔组(30例)和经后腹膜组(26例),比较两组患者术中相关指标(包括手术时间、术中出血量、有无输血、中转开腹及术中并发症)及术后相关指标(包括入ICU例数、开始进食时间、住院天数、全身炎症反应综合征及并发症发生情况)。结果经后腹膜组患者手术时间和术后开始进食时间均显著短于经腹腔组(P_均<0.05),其他指标比较差异均无显著性(P_均> 0.05)。结论经腹腔和经后腹膜入路行腹腔镜根治性肾切除术均安全可行,经验丰富的术者应于术前充分评估患者具体情况和手术难度,合理把握适应证,选择最有利于患者的手术方式。

Objective To compare the clinical effect and safety of laparoscopic radical nephrectomy through transperitoneal and retroperitoneal approaches. Method The clinical data of 56 patients undergoing laparoscopic radical nephrectomy in our hospital from March 2007 to September 2017 were analyzed retrospectively, they were divided into transperitoneal group(n = 30) and retroperitoneal group(n = 26) according to the way of operation. The intraoperative related indexes(including operation time,intraoperative blood loss, blood transfusion, conversion to laparotomy and complications) and postoperative related indexes [including the number of cases entering ICU, time to start eating after operation, the number of days in hospital, the occurrence of systemtic in?ammation response syndrome(SIRS) and complications] were compared between the two groups. Result The time of operation and time to start eating after operation in retroperitoneal group were signi?cantly shorter than those in transperitoneal group(Pall<0.05),but there were no signi?cant differences in other indexes(Pall> 0.05). Conclusion Therapeutic laparoscopy through transperitoneal and retroperitoneal approach is all safe and feasible, operators should fully evaluate the speci?c situation of patients and the dif?culty of operation before operation, reasonably grasp the indications, and choose the most favorable surgical method for patients.