后腹腔镜下与开放根治性肾切除术治疗T1肾癌的疗效比较  

Retroperitoneal laparoscopic versus open radical nephrectomy in T1 renal cell carcinoma

作　　者：王林辉[1] 王梁[1] 杨波[1] 杨庆[1] 肖成武[1] 孙颖浩[1] 

机构地区：[1]第二军医大学长海医院泌尿外科,上海200433

出　　处：《中华泌尿外科杂志》2009年第4期228-230,共3页Chinese Journal of Urology

摘　　要：目的评价后腹腔镜下肾癌根治术治疗T1肾癌的临床疗效。方法T1肾癌患者352例，均由同一组医生完成肾癌根治术，其中行后腹腔镜下手术组185例、开放性手术组167例，2组患者年龄、性别、肿瘤大小、分期、SCr值差异均无统计学意义。分析比较2组患者手术时间、术中出血量、住院时间、手术并发症及生存率的差异。结果后腹腔镜组与开放手术组手术时间为55～130（75．6±11．2）min与50～140（68．0±10．6）min（P〉0．05）；术中出血量50～1200（110．6±32．3）ml与50～1500（160．8土38．1）ml、术后需用止痛药治疗8例与132例、术后进食时间1～2（1．3±0．5）d与2～5（2．9±1．2）d、术后住院时间3～7（4．6±1．2）d与7～14（8．9±1．6）d，差异均有统计学意义（P〈0．05）。术后中位随访时间25（6～42）个月，2组生存率（85．4％与86．2％）差异无统计学意义（P〉0．05）。结论与开放性肾癌根治术相比，后腹腔镜下肾癌根治术出血少、恢复快、术后并发症少，已成为T1肾癌手术治疗的金标准。Objective To compare the clinical outcomes of retroperitoneal laparoscopic and open radical nephrectomy in patients with T1 renal cell carcinoma （RCC）. Methods 352 patients underwent radical nephrectomy for T1 RCC, 185 by retroperitoneal laparoscopic radical nephrectomy（group A） and 167 by open radical nephrectomy through an extraperitoneal flank incision（group B）. The operation time, blood loss during operation, hospital stay and complication after surgery were analyzed and compared. All the cases were followed up for 6-42 months（median, 25 months） and the survival rates were recorded. Results The operation time of group A, B was 55-130（75.6±11.2）rain vs. 50-140（68. 0±10. 6）min（P〉0.05）. Blood loss was 50-1200（110. 6±32. 3）ml vs. 50- 1500 （160.8±38.1）ml（P〈0.05）. Eight cases of group A and 132 cases of group B took analgesic after surgery（P〈0.05）. The fasting period was 1 -2（1.3±1-0.5）day vs. 2-5（2.9±1.2）d of group B （P〈0. 05） ;length of hospital stay was 3-7（4.6±1.2）d vs. 7-14（8.9±1.6）d（P〈0.05）. The survival rate was 85.4% vs. 86.2% （P〉0.05）. Conclusions Compared with open radical nephrectomy, retroperitoneal laparoscopic radical nephrectomy is associated with lower blood loss, narcotic requirement and complications, a shorter hospital stay and earlier resumption of routine activities. Retroperitoneal laparoscopic radical nrphrectomy has become a gold standard therapy in T1 renal cell carcinoma.

关 键 词：肾肿瘤 癌 腹腔镜 

分 类 号：R686[医药卫生—骨科学]