腹腔镜治疗大体积肾癌的临床经验及与开放手术的比较  

Comparison of clinical outcomes of laparoscopic versus open radical nephrectomy for large renal tumors

作　　者：方冬[1] 杨恺惟[1] 李学松[1] 杨新宇[1] 唐琦[1] 唐渊[1] 张崔建[1] 张骞[1] 何志嵩[1] 周利群[1] 

机构地区：[1]北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿,男性生殖系肿瘤研究中心

出　　处：《现代泌尿外科杂志》2013年第6期553-556,共4页Journal of Modern Urology

摘　　要：目的探讨腹腔镜治疗大体积(直径>7cm)肾癌的临床应用价值,并与开放手术的疗效进行比较。方法回顾性分析2001年10月至2012年6月于北京大学第一医院接受肾根治性手术治疗、术后病理诊断为肾癌且肿瘤最大直径>7cm患者的临床资料。统计患者各项围手术期信息,进行腹腔镜手术和开放手术的对比。结果共388例患者入组,其中腹腔镜手术71例,开放手术317例。腹腔镜手术组包括23例经腹腔入路和48例经腹膜后入路,较开放组患者相比,腹腔镜组术中出血量少(358.73mL vs.462.02mL,P=0.002),术后住院日短(6.59dvs.8.87d,P=0.000),但手术时间偏长(197.60min vs.173.07min,P=0.003),肿瘤体积较小(8.82cmvs.9.50cm,P=0.018)。结论采用腹腔镜手术治疗大体积肾癌安全可行,具有创伤小、恢复快的优势。对于有一定腹腔镜手术基础的医师,在合理把握适应证、选择合适手术入路的基础上,可以开展腹腔镜手术治疗大体积肾癌。但尚需进一步研究来了解其远期肿瘤控制结果。Objective To explore the clinical experience of laparoscopic surgery for large renal tumors and to compare the outcomes of laparoscopic versus open surgery. Methods Data of patients with renal tumors more than 7 cm who underwent radical nephreetomy during Oct. 2001 to Jun. 2012 were collected and analyzed. The operation time,blood loss,and post- operative hospital stay of laparoscopic and open surgery were compared. Results A total of 388 patients were enrolled,including 71 treated with laparoscopic radical nephrectomy and 317 undergoing open surgery. Compared with patients treated with open surgery,patients in the laparoscopy group had less blood loss （358.73 mL vs 462.02 mL, P=0. 002） ,shorter post-operative hospital stay （6.59 d vs. 8.87 d, P=0. 000）,smaller tumor size （8.82 cm vs. 9.50 cm, P=0. 018）,but longer operation time （197.60 min vs, 173.07 min,P=0. 003）. Conclusions For large renal tumors,laparoscopic radical nephrectomy is feasible based on proper operative indications and approach, but the long-term outcome should be further observed.

关 键 词：大体积肾癌 腹腔镜手术 开放手术 肾根治性切除术 

分 类 号：R699.2[医药卫生—泌尿科学]