不同入路腹腔镜下肾部分切除术治疗早期肾癌临床对比研究  

Clinical study of laparoscopic partial nephrectomy for different treatments of early renal cell carcinoma

作　　者：韩生禄 刘海莲 付德来[3] 赵留存 杨勇 杨京可 周克斌 董小鑫 HAN Shenglu;LIU Hailian;FU Delai(Department of Urinary Surgery,Xi’an No.9 Hospital,Xi’an 710054)

机构地区：[1]西安市第九医院泌尿外科,西安710054 [2]西安市工会医院儿科,西安710100 [3]西安交通大学第二附属医院泌尿外科,西安710004

出　　处：《陕西医学杂志》2020年第1期33-36,共4页Shaanxi Medical Journal

基　　金：西安市卫生和计划生育委员会科研课题(2015-08)

摘　　要：目的:探讨腹腔镜下肾部分切除术治疗早期肾癌时后腹腔入路和经腹腔入路两种入路的有效性和安全性。方法:采用随机抽签方式将40例早期肾癌(T1N0M0)患者均分为后腹腔组和经腹腔组(各20例)。两组患者均接受腹腔镜下肾部分切术进行肾癌治疗,其中后腹腔组手术入路选择经后腹腔,经腹组手术入路选择经腹腔。比较两组术中热缺血时间、失血量、术后时间、肿瘤重量、术后饮食恢复时间、住院时间及围手术期并发症发生情况;测定两组血清应激反应指标白细胞计数(WBC)、C反应蛋白(CRP)和皮质醇表达水平;统计两组术中切缘冷冻切片病理学检查及随访结果。结果:两组肿瘤患者均顺利完成肾部分切除手术。围手术期,后腹腔组和经腹腔组患者热缺血时间、术中失血量、肿瘤重量及并发症发生率情况间比较差异无统计学意义(P>0.05);但后腹腔组手术时间、术后饮食恢复时间和住院时间明显短于经腹腔组,WBC、CRP、皮质醇表达水平明显低于经腹腔组(P<0.05)。两组肾癌患者术中切缘组织冷冻切片均为阴性,术后随访,后腹腔组仅1例复发,经腹腔组无复发病例,两组复发率间比较差异无统计学意义(P>0.05)。结论:直径≤4 cm的早期肾癌患者腹腔镜下肾部分切除术治疗中,后腹腔入路和经腹腔入路均具有良好有效性和安全性,但经后腹腔入路手术时间短,机体应激刺激小,患者术后康复快。Objective:To evaluate the efficacy and safety of laparoscopic partial nephrectomy for the treatment of early renal cell carcinoma with posterior abdominal approach and transperitoneal approach.Methods:Forty patients with early renal cell carcinoma(T1N0M0) included in the study were randomly divided into the posterior abdominal group and the abdominal cavity group(20 cases in each group).Both groups underwent laparoscopic partial nephrectomy for renal cell carcinoma.In the choice of approach,the posterior abdominal group was selected through the posterior abdominal cavity,and the abdominal cavity group was selected through the abdominal cavity.The duration of warm ischemia,blood loss,postoperative time,tumor weight,postoperative dietary recovery time,hospitalization time and perioperative complications were compared between the two groups.The serum stress response indicators of white blood cell count(WBC),C-reactive protein(CRP) and cortisol levels were measured.The pathological examination and follow-up results of frozen margin sections of the two groups were performed.Results:Both groups of tumor patients successfully completed partial nephrectomy.There was no significant difference in the time of warm ischemia,intraoperative blood loss,tumor weight and complication rate between the posterior abdominal group and the abdominal cavity group(P>0.05).However,the operation time,postoperative dietary recovery time and hospitalization time of the posterior abdominal group were significantly shorter than those of the abdominal cavity group,the expression levels of WBC,CRP and cortisol in the posterior abdominal group were significantly lower than those in the abdominal cavity group(P<0.05).In the two groups of patients with renal cell carcinoma,the frozen section of the marginal tissue was negative.There was only one case of recurrence in the posterior abdominal group,and there was no recurrence in the abdominal cavity group,and the difference in recurrence rate between the two groups was infini-te(P>0.05).Conclusion:La

关 键 词：肾癌 手术疗法 肾部分切除 手术入路 效果 安全性 

分 类 号：R737.11[医药卫生—肿瘤]