大体积肾癌微创手术患者的入路方案研究  

Comparison of different approaches of laparoscopic radical nephrectomy for large renal cell carcinoma

作　　者：黄超[1] 成泽民[1] 杜义堂 曾东升[1] 任衢军 包伟[1] 袁宗琳 

机构地区：[1]四川省达州市中心医院泌尿外科,四川达州635000

出　　处：《中国内镜杂志》2015年第8期857-860,共4页China Journal of Endoscopy

摘　　要：目的探讨经腹及经后腹腹腔镜两种手术入路行大体积肾癌(直径>7 cm)切除术的疗效,为其临床应用提供可参考依据。方法共纳入80例该院诊断为大体积肾癌的患者作为研究对象,采用随机数字法平均分为经腹腔组与经腹膜后组两组,分别给予经腹腔入路大体积肾癌切除术及经腹膜后入路大体积肾癌切除术。比较两组疗效,记录手术开始、气腹后、分离时及手术结束后患者的心率、平均动脉压及中心静脉压、手术时间、术中出血量和住院时间等。结果经腹腔入路手术时间、最大肿瘤直径、术后排气时间及住院时间均明显高于经腹膜后组,差异有统计学意义(P<0.05)。两组患者在手术开始、气腹后、分离时及手术结束后4个不同时间段组间及组内比较心率、平均动脉压和中心静脉压,差异均无统计学意义(P>0.05)。经腹腔入路术后T分期明显高于经腹膜后组,差异有统计学意义(P<0.05)。结论大体积(直径>7 cm)的肾癌经腹腔及经腹膜后入路行腹腔镜均有较好的疗效,虽然经腹膜后入路手术时间更短,术后恢复更快,但临床上对于体积>10 cm和T分期高的肾癌更倾向于选择经腹腔入路。[ Objective ] To compare the clinical efficacy of laparoscopic radical nephrectomy for large renal cell carcinoma （〉7 cm） between retroperitoneal approach and transperitoneal approach. [ Methods ] We collected and an- alyzed the data of 80 patients with renal tumors who underwent laparoscopic radical nephrectomy, with tumor size larger than 7 cm by pathology, and compared the perioperative outcomes between transperitoneal and retroperitoneal approach. [ Results ] The surgical time, maximum tumor diameter, length of hospital stay and postoperative exhaust time in abdominal approach group were higher than those in retroperitoneal approach. The difference was statistically significant （P 〈 0.05）. There were no differences in the heart rate, mean arterial pressure and central venous pressure during and after the surgery （P 〉 0.05）. Analysis of the pathologic features indicated that tumors with higher T stage were more likely resected with transperitoneal approach. [ Conclusions ] Laparoscopic partial nephrectomy can be performed efficiently and effectively with the retroperitoneal and transperitoneal approach. While for renal cancer with volume 〉 10 cm and higher T stage, it is more inclined to choose the abdominal approach.

关 键 词：大体积肾癌 腹腔镜 腹腔入路 腹膜后入路 

分 类 号：R737.11[医药卫生—肿瘤]