腹腔镜与开放肾切除术的对比研究  

A comparative study of laparoscopic and open nephrectomy

作　　者：敖平[1] 徐忠华[2] 闫磊[2] 周尊林[2] 范医东[2] 刘照旭[2] 郑宝钟[2] 

机构地区：[1]皖南医学院弋矶山医院,安徽皖南241000 [2]山东大学齐鲁医院

出　　处：《腹腔镜外科杂志》2009年第2期94-98,共5页Journal of Laparoscopic Surgery

摘　　要：目的:探讨非肿瘤性无功能肾患者行腹腔镜肾切除术的可行性,并与开放手术进行对比研究。方法:1997年8月至2007年10月我们为85例患者行单纯性肾切除术,其中腹腔镜手术32例(23例经侧腹腔途径,9例经腹膜后途经),开放性手术53例。比较两种方法的手术时间,出血量,术后引流量、胃肠功能恢复时间、下床活动时间、住院天数,住院总费用及止痛药的应用等指标。结果:85例手术均获成功,无术中及术后严重并发症发生。腹腔镜手术组无中转开放者。腹腔镜手术组术中出血量,术后胃肠功能恢复时间、引流量、下床活动时间、住院天数及止痛药应用等指标均低于开放手术组(P<0.05),手术时间及住院总费用则高于开放手术组(P<0.05)。结论:与开放手术相比,腹腔镜单纯性肾切除术具有患者出血少、创伤轻、康复快等优点,适于多种非肿瘤性无功能肾的切除。随着术者经验的积累、操作技术水平的提高以及腹腔镜技术的发展,腹腔镜手术的操作时间及患者的住院费用可接近开放手术。Objective：To investigate the feasibility of laparoscopic nephrectomy for benign nonfunctioning kidneys by comparing the clinical outcomes versus open surgery. Methods ：Eighty-five cases underwent simple nephrectomy from August 1997 to October 2007 in our hospital. Laparoscopic simple nephrectomy （LSN） was performed for 32 cases （23 lateralperitoneal approach and 9 retroperitoneal approach,and 53 cases of benign nonfunctioning kidneys underwent open nephrectomy during the same period. Clinical data including the operative time, intraoperative blood loss, postoperative drainage volume, postoperative intestinal function recovery time, postoperative ambulation time, use of antalgesic, postoperative hospital stay and total cost of hospitalization were recorded and compared between the two groups. Results： All of the operations were successfully performed. There were no severe peri- or postoperative complications that could be related to the operations. In no instance did the laparoscopic procedure need to be converted to open surgery. The intraoperative blood loss, postoperative drainage volume, postoperative intestinal function recovery time, postoperative ambulation time, postoperative hospital stay and use of antalgesic in the LSN group were significantly less than those in the open group （P 〈 0.05）, while the operative time and the total cost of hospitalization were more than those in the open group（ P 〈 0.05）. Conclusions： LSN has advantages over open nephrectomy, namely a smaller wound,less blood loss, more rapid recovery and so on. These benefits outweigh the longer operative time and the higher hospital charges associated with the laparoscopic approach. It may provide a safe and effective method for resecting benign nonfunctioning kidneys. With the accumulation of experience and the development of laparoscopic techniques, the operative time and hospitalization cost in most LSN cases can be equal to open operations.

关 键 词：肾疾病 肾切除术 腹腔镜术 

分 类 号：R699.2[医药卫生—泌尿科学]