后腹腔镜下与开放性肾癌根治术治疗局限性肾癌的比较  

Retroperitoneal Laparoscopy vs.Open Approach to Nephrectomy in Localized Renal Cell Carcinoma

作　　者：项明峰[1] 刘飞[1] 赵为广[2] 潘正跃[1] 史子敏[1] 习小庆[1] 黄红卫[1] 胡映波[1] 

机构地区：[1]南昌大学第二附属医院泌尿外科,南昌330006 [2]天津医科大学第二医院泌尿外科

出　　处：《临床泌尿外科杂志》2011年第5期333-335,共3页Journal of Clinical Urology

摘　　要：目的:评价后腹腔镜肾癌根治术治疗局限性肾癌的临床疗效。方法:局限性肾癌患者70例,其中行后腹腔镜下肾癌根治术(后腹腔镜组)30例,开放性肾癌根治术(开放手术组)40例,2组患者年龄、性别、肿瘤分期大小差异无统计学意义,分析比较两组患者手术时间、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相比:手术时间为90～360(110±11.3)mm与100～150(100±10.5)mm,差异有统计学意义(P>0.05),后腹腔镜组费时较长;术中出血50～1 600(108.6±28.3)ml与70～1 100(1 62.8±40.1)ml(P<0.05);术后需用镇痛剂8例与32例(P<0.05)、术后进食时间1～2(1.3±0.5)天与3～5(3.1±1.1)天(P<0.05)、术后住院3～7(4.5±1.3)天与7～13(8.8±1.7)天(P<0.05),差异均有统计学意义。术后中位随访时间23个月(5～40个月),生存率差异无统计学意义(P>0.05)。结论:与开放肾癌根治术相比,后腹腔镜下肾癌根治术出血少、恢复快、术后并发症少,已成为局限性肾癌的首选治疗方法。Objective：To appraise the clinical outcome in localized renal cell carcinoma （RCC） of patients who undergoing retroperitoneal laparoscopic radical nephrectomy. Methods：70 patients underwent radical nephrectomy for localized RCC, and all operation completed by the same platoon doctors. 30 by retroperitoneal laparoscopic radical nephrectomy and 40 by open radical nephrectomy through an extraperitoneal llth rib flank incision. There is no statistically significant difference in the 2 groups’ data. The operation time, blood loss during operation, hospital stay and complication after surgery were analyzed and compared. All the cases were followed up for 5-40 months（mean times 23 months） and the survival rates, wound healing, and carcinoma metastasis were recorded. Results：compared retroperitoneal laparoscopic radical nephrectomy with open radical nephrectomy： operation time 90-360 min（mean 110±11.3 min） vs. 100-150 min（mean 100±10.5 min）（P〉0.05）. Blood loss 50-1 600 ml （mean 108.6±28.3 ml） vs. 70-1 100 ml（mean 162.8±40.1 ml P〈0.05） ;total narcotic requirement after surgery 8 vs. 32（P〈0.05）. fasting period 1-2 day（mean 1.3±0.5 d） vs. 3-5 day（mean 3.1±1.1 d ,P〈0.05） ;length of hospital stay 3-7 day（mean 4.5±1.3 d）vs. 7-13 day（mean 8.8±1.7 d ,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 nephrectomy has become the first therapy in localized renal cell carcinoma.

关 键 词：腹膜后腹腔镜 微创 局限性肾细胞癌 肾切除术 

分 类 号：R737.11[医药卫生—肿瘤]