肾肿瘤后腹腔镜肾部分切除术转手助腹腔镜手术效果观察  

Efficacy Observation of Hand-Assisted Laparoscopic Converted from Retroperitoneal Laparoscopy Partial Nephrectomy

作　　者：赵国斌[1] 李向东[1] 唐玉红[2] 孔雁萍[1] 张秀梅 苗文隆[1] 凌海滨[1] 张潮[1] 

机构地区：[1]河北北方学院附属第一医院泌尿外科,河北张家口075000 [2]河北北方学院检验学院,河北张家口075000 [3]张家口市沙岭子医院急诊科,河北张家口075000

出　　处：《临床误诊误治》2015年第6期32-35,共4页Clinical Misdiagnosis & Mistherapy

基　　金：河北省医学科学研究重点课题计划指令项目(ZL20140296);张家口市科学技术与发展指导计划项目(1321124D);河北北方学院青年基金项目(Q201126)

摘　　要：目的：观察肾肿瘤后腹腔镜肾部分切除术转手助腹腔镜手术的临床效果。方法选择2009年2月—2013年2月由单一术者完成的肾肿瘤后腹腔镜肾部分切除术中因粘连、出血、肿瘤位置复杂等原因改变术式的27例,随机分为手助腹腔镜组14例、开腹手术组13例,观察比较两组手术时间、出血量、切口长度、术后下床活动时间、住院时间、肾缺血时间等指标及并发症发生情况、预后,并比较两组C反应蛋白（CRP）及白细胞介素6（IL-6）浓度变化。结果本研究27例均顺利完成手术,手助腹腔镜组手术时间、出血量、切口长度、下床活动时间、住院时间均明显少于开腹手术组,差异均有统计学意义（P〈0．01,P〈0．05）；肾脏热缺血时间较开腹手术组稍长,两组比较差异无统计学意义（P〉0．05）。术后1、3 d两组CRP及IL-6浓度均显著高于术前,但手助腹腔组术后CRP、IL-6浓度显著低于开腹手术组（P〈0．01）。开腹手术组1例损伤腔静脉,术中修复,两组均无术后并发症发生。两组术后随访10~58个月,未发现肿瘤局部复发。结论肾肿瘤后腹腔镜肾部分切除术转手助腹腔镜手术创伤小、出血少、恢复快,安全可靠。Objective To observe the clinical results of hand-assisted laparoscopic partial nephrectomy converted from retroperitoneal laparoscopy. Methods During 2009 Feb. And 2013 Feb. , 27 patients underwent retroperitoneal lapa-roscopy partial nephrectomy, and operative style conversion for adhesion, bleeding, complex tumor location, etc. Randomly divided into two groups, 14 cases were converted to hand-assisted laparoscopic, and 13 to open surgeries. The tumor sizes , surgery time, loss of blood, incision length, off bed time, postoperative hospital stay, and renal ischemia time, prognosis, and concentration of CRP and IL-6 were compare. Results All the 27 operations were performed successfully. The surgery time, bleeding amount, incision length and off bed time of hand-assisted laparoscopic group were all less than that of open sur-gery group（P〈0. 01 or P〈0. 05）;but renal ischemia time was longer than that of open surgery group, and the differences showed no statistical significance（ P〉0. 05 ） . The concentration of CRP and IL-6 on postoperative 1 d and 3 d of the two groups were significantly higher than the preoperative level（P〈0. 01）, but The concentration of CRP and IL-6 post-operation of hand assisted laparoscopic group were significantly lower than that of open surgery group （P〈0. 01）. In the open operation group there was 1 case of vena cava injury, and after intraoperative repair, patients of two groups had no complications after. Two groups were followed up for 10-58 months, no recurrence was found. Conclusion Retroperitoneal laparoscopy partial ne-phrectomy converted into hand-assisted laparoscopic is less invasive with less loss of blood but a quicker recovery.

关 键 词：肾肿瘤 腹腔镜检查 肾部分切除术 手助腹腔镜检查 

分 类 号：R737.11[医药卫生—肿瘤]