腹腔镜与开放肾部分切除术疗效及围手术期并发症的对比研究  

Comparison of the clinical outcome and perioperative complications between the laparoscopic and the open partial nephrectomy

作　　者：杨琦[1] 王养民[1] 常德辉[1] 周逢海[1] 董永超[1] 杨旭凯 乔够梅[1] 焦鸿梅[1] 

机构地区：[1]中国人民解放军兰州总医院全军泌尿外科中心,730050

出　　处：《临床外科杂志》2018年第2期127-130,共4页Journal of Clinical Surgery

基　　金：甘肃省自然科学基金(145RJZA138)

摘　　要：目的比较腹腔镜肾部分切除术(laparoscopic partial nephrectomy,LPN)与开放肾部分切除术(open partial nephrectomy,OPN)治疗T1期肾癌的疗效及安全性。方法行肾部分切除术的T1期肾癌病人177例,其中96例行腹腔镜肾部分切除术(LPN组),81例行开放肾部分切除术(OPN组),比较两组病人的围手术期情况、肾功能变化及并发症发生情况等。结果 177例手术均顺利完成,无术中输血,无围手术期死亡。LPN组和OPN组的手术时间分别为(141.0±29.9)分钟和(117.2±25.2)分钟,术中出血量分别为(125.8±56.1)ml和(196.6±83.0)ml,患肾热缺血时间分别为(27.1±7.6)分钟和(22.2±5.5)分钟,术后24小时视觉模拟评分(VAS)分别为(4.7±0.6)分和(6.7±0.5)分,术后72小时全身炎症反应综合征(SIRS)发生率分别为33.3%(32/96)和49.4%(40/81),术后排气时间分别为(2.1±0.7)天和(2.9±1.0)天,术后住院时间分别为(8.6±2.2)天和(11.6±3.0)天,差异均有统计学意义(P<0.05)。两组病人手术切缘均为阴性,术后并发症发生率分别为16.7%(16/96)和16.0%(13/81),手术前后血清肌酐变化值分别为(11.5±9.0)μmol/L和(10.6±11.8)μmol/L,患肾肾小球滤过率变化值分别为(8.7±1.8)ml/min和(8.3±1.4)ml/min,差异均无统计学意义(P>0.05)。结论 LPN治疗T1期肾癌安全有效,与开放手术比较,虽然手术时间及患肾热缺血时间较长,但能够显著减少术中出血量,减轻机体创伤和术后疼痛,促进病人快速康复,且对患肾功能的影响与开放手术接近。Objective To compare clinical outcome and perioperative complications between the laparoscopic partial nephrectomy（LPN）and the open partial nephrectomy（OPN）in the treatment of renal cell carcinoma（T1 N0 M0）.Methods A retrospective study was performed on 177 cases of patients with renal cell carcinoma（T1 N0 M0）,who underwent partial nephrectomy from January2010 to December 2016.Among the patients,96 cases underwent LPN were made as the LPN group,and 81 cases underwent OPN were made as the OPN group.The perioperative parameters,renal function and surgery-related complications were compared between the two groups.ResultsNo cases were required transfusion or died in the perioperative period.There were significant differences in the operative time[（141.0±29.9）mins vs.（117.2±25.2）mins],blood loss[（125.8±56.1）ml vs.（196.6±83.0）ml]and warm ischemia time[（27.1±7.6）mins vs.（22.2±5.5）mins]between the LPN group and OPN group（P〈0.05）.The visual analogue scale（VAS）was（4.7±0.6）in the LPN group and（6.7±0.5）in the OPN group at the 24 th hour after the surgery（P〈0.05）.The incidence of systemic inflammatory response syndrome（SIRS）was 33.3%（32/96）in the LPN group and 49.4%（40/81）in the OPN group at the 72 th hour after the surgery（P〈0.05）.The time to resume intestinal function was（2.1±0.7）d vs.（2.9±1.0）d between the LPN group and the OPN group（P〈0.05）.The postoperative length of hospital stay was（8.6±2.2）d vs.（11.6±3.0）d between the LPN group and the OPN group（P〈0.05）.There was no case with positive surgical margin,and 16 cases（16.7%）in the LPN group and 13 cases（16.0%）in the OPN group were suffered from surgery-related complications after operation（P〈0.05）.There was no significant difference in the increment of creatine[（11.5±9.0）μmol/L vs.（10.6±11.8）μmol/L]and decrement of glomerular filtration rate（GFR）[（8.7±1.8）ml/min vs.（8.3±1.4）ml/min]between the LPN group and the OPN

关 键 词：肾肿瘤 肾部分切除术 腹腔镜 开放手术 并发症 

分 类 号：R737.11[医药卫生—肿瘤]