经第9肋间胸腹联合切口与腰部切口切除巨大肾肿瘤的疗效比较  

A prospective study of the efficacy of thoracoabdominal incision for nephrectomy:a comparison with the lumber approach

作　　者：杨明根[1] 赵晓昆[1] 

机构地区：[1]中南大学湘雅二医院泌尿外科,长沙410011

出　　处：《临床泌尿外科杂志》2008年第4期297-300,共4页Journal of Clinical Urology

摘　　要：目的:比较经胸腹联合切口及经腰部切口切除巨大肾肿瘤的疗效。方法:对60例巨大肾肿瘤患者,32例经第九肋间胸腹联合切口(胸腹切口组)、28例经腰部切口(腰部切口组)手术切除。对两组患者的手术时间、术中失血等相关指标进行比较。结果:胸腹切口组平均手术时间、术中出血量、肿瘤大小及生存率分别为(117.3±8.1)min、(150.2±10.1)ml、(20.17±2.23)cm和96.7%;腰部切口组分别为(123.6±4.9)min、(209.9±12.7)ml、(18.00±2.19)cm和78.6%,两组差异有统计学意义(P<0.05);术后胃肠功能恢复腰部切口组优于胸腹切口组;术后拔除引流管时间、使用止痛药的病例数及时间、下床活动时间、住院天数、疼痛消失时间、并发症、恢复正常活动及工作时间两组无明显差异。结论:与传统的经腰部切口相比,经胸腹联合胸腹切口具有显露好、视野开阔,手术时间短、出血少等优点,是一种安全、有效的途径。Objective：To prospectively compare radical nephrectomy with thoracoabdominal incision or lumber incision for the surgical treatment of large renal tumors. Methods： Clinical data of 32 large renal tumors of thoracoabdominal incision radical nephrectomy （Group 1）and 28 cases of flank incision radical nephrectomy （Group 2） from January 2003 to December 2006 in this hospital were retrospectively analyzed and compared in respect of operation time, hemorrhage volume in operation, use of painkiller, fasting period after operation, and postoperative hospitalization. All the cases were followed up for 6-30 months and the times of discontinuation of pain medication, return to daily activities and work after surgery, the survival rates, and complications were recorded. Results： Patients in both groups were all successfully treated and their sexes, clinical stages and ages were all comparable. The operation time in group 1（117.3±8. 1） min was shorter than that in group 2（123.6±4.9） min （P= 0. 001）. The hemorrhage volume in operation in group 1 （ 150.2±10. 1） ml was significantly less than that in group 2 （209.9±12.7） ml （P〈0. 001 ）. Mean size of tumors in group 1 was larger than that in group 2 obviously （P=0. 001）. The survival rate in group 1 is higher than that in group 2. The fasting period in group 2 （62.79±6.50） h was shorter than that in group 1 （66.93±3.17） h （P=0. 004）. The removed drainage tube time, length of off-bed time and stay were the same in both groups. There were no significant differences between groups in times following surgery when pain completely disappeared, rate of complications, when pain medications were discontinued, and when the patient returned to daily activities and work （P〉0.05）. Conclusion： Compared with lumber incision, thoracoabdominal incision has the advantages of shorter operation time, less blood loss, and better exposure, being a safe and effective curative method.

关 键 词：肾肿瘤 胸腹联合切口 腰部切口 肾切除术 

分 类 号：R737.11[医药卫生—肿瘤]