经脐单孔多通道腹腔镜肾癌根治术与标准腹腔镜肾癌根治术临床疗效对比研究  

Laparoendoscopic single-site(LESS)radical nephrectomy and standard laparoscopy:a comparison of therapeutic outcomes

作　　者：吴震杰[1] 蔡晨[2] 王林辉[1] 杨庆[1] 刘冰[1] 唐守艳[1] 陈伟[1] 盛海波[1] 王承[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 [2]第二军医大学长海医院特需诊疗科,上海200433

出　　处：《第二军医大学学报》2011年第10期1069-1075,共7页Academic Journal of Second Military Medical University

基　　金：上海市市级医院新兴前沿技术联合攻关项目(SHDC12010115);军队临床高新技术重大项目(2010gxjs057);上海市重点学科项目~~

摘　　要：目的通过与标准经腹腹腔镜肾癌根治术进行对照研究,评价经脐单孔多通道腹腔镜肾癌根治术的临床疗效。方法 2008年9月至2011年1月,本单位同一手术组共完成经腹腹腔镜肾癌根治术105例,其中经脐单孔腹腔镜肾癌根治术21例,标准经腹腹腔镜肾癌根治术84例。回顾性分析和比较21例单孔腹腔镜肾癌根治术(A组,2009年9月至2011年1月)和21例标准经腹腹腔镜肾癌根治术(B组,2008年9月至2010年3月)的临床资料和随访信息。两组的配比因素为:患者年龄、体质指数、肿瘤最大径及位置、手术适应证(T1期)。结果 A、B两组的术后疼痛评分分别为3.5±0.84和4.1±1.06,术后肠道功能恢复时间分别为(31.6±17.98)、(42.3±19.94)h,手术切口满意度评分分别为8.2±0.71和7.3±0.85,差异均有统计学意义(P<0.05)。两组的前10例手术时间差异有统计学意义(P=0.030),但后10例(P=0.495)及总体(P=0.076)手术时间差异均无统计学意义。术后随访时间分别为(8.4±4.41)和(20.0±3.95)个月(P=0.000),两组患者均未出现肿瘤复发或转移。结论与标准经腹腹腔镜肾癌根治术相比,经脐单孔多通道腹腔镜手术患者术后疼痛轻,肠道功能恢复快,切口满意度高,但肿瘤治疗效果仍需进一步长期随访予以证实。Objective To compare the therapeutic outcomes of laparoendoscopic single-site（LESS）radical nephrectomy and standard laparoscopy,so as to understand the clinical advantages of transumbilical LESS radical nephrectomy.Methods Between Sep.2008 and Jan.2011,a single urologist in our center performed 105transperitoneal laparoscopic radical nephrectomies,including 21transumbilical LESS radical nephrectomies（Group A,Sep.2009and Jan.2011）.This group was subsequently matched to 21standard laparoscopic RN procedures（Group B,Sep.2008 and Mar.2010）.The perioperative outcomes and follow-up information,including scores of cosmetic satisfaction,were retrospectively analyzed in the two groups.The two groups were matched in patient age,body mass index,tumor size and location,and surgical indication（T1 stage）.Results The LESS group had significantly quicker bowel function recovery（[31.6±17.98]h vs[42.3±19.94]h,P 〈0.05）,lower postoperative pain score（3.5±0.84vs 4.1±1.06,P〈0.05）,and a better cosmetic satisfaction score（8.2± 0.71vs 7.3±0.85,P〈0.05）.Notably,the mean operation periods for the first 10cases were significantly different between the two groups（P=0.030）,but not significantly for the last 10cases（P=0.495）and for the whole group（P=0.076）.Both groups remained metastasis-and recurrence-free during mean follow-up periods of（8.4±4.41）and（20.0±3.95）months（P=0.000）.Conclusion The transumbilical LESS radical nephrectomy offers a better postoperative pain control,quicker recovery of bowel function,and a better cosmetic satisfaction compared with standard nephrectomy,but its therapeutic effect needs to be verified by long-term follow-up.The learning curve of this procedure appears not so steep for an experienced laparoscopist following a strict specialized training course

关 键 词：单孔腹腔镜手术 肾癌根治术 肾肿瘤 

分 类 号：R737.11[医药卫生—肿瘤]