后腹腔镜肾部分切除术与开放手术治疗小肾癌的临床疗效比较

摘要

Objective To analyze and compare the safety and efficacy of retroperitoneal laparoscopic partial nephrectomy ( RLPN ) and open partial nephrectomy ( OPN ) for small renal cell carcinoma. Methods A total of 67 cases, suffering from small renal cell carcinoma ( Tl aNOMO ) from January 2005 to November 2011 were analyzed retrospectively, 32 of which underwent retroperitoneal RLPN and the other 35 patients underwent OPN. The operation time, blood loss, warm ischemia time, surgical margins, complications, postoperative hospital stay and follow-up results between the two groups were compared and analyzed. Results The operation time, blood loss, warm ischemia time and postoperative hospital stay of RLPN and OPN group were( 178. 3 ±45. 7 )min and( 134. 6 ±43. 9 )min, (l07.3±54.3)mL and(l35.5±48.0)mL,(31.3±13.1 )min and( 21. 8 ± 10. 5 )min,( 11. 6 ±4. 2 )d and( 15.1 ±3. 5 )d respectively. There were statistical significance between the two groups ( P <0. 05 ). One case was converted to open surgery due to intraoperative blood loss. Three cases in RLPN group and two cases in OPN group (9.4% vs5.7%,P>0. 05) needed blood transfusion. All surgical margins were negative. The follow-up of the two groups was 4-86 months,one case( 3. 1% ) in RLPN group and two cases( 5. 7% ) in OPN group ( P > 0. 05 ) recurred. Conclusion RLPN and OPN have the same safety and efficacy. Due to operating technology, for experienced surgeon, RLPN treatment can be the first choice for selected patients of small renal cell carcinoma because of its fast recovery.%目的 通过与传统开放性肾部分切除术(open partial nephrectomy,OPN)比较,探讨后腹腔镜肾部分切除术(retroperitoneal laparoscopic partial nephrectomy,RLPN)治疗小肾癌的安全性和可行性.方法 回顾性分析2005年1月-2011年11月确诊为T1aN0M0的肾癌患者67例,其中RLPN组32例和OPN组35例,比较2组的手术时间、术中出血量、肾动脉阻断时间、手术切缘情况、手术并发症、术后住院时间及随访结果等.结果 RLPN组与OPN组手术时间、术中出血量、肾动脉阻断时间和术后住院时间分别为(178.3±45.7)min和(134.6±43.9)min、(107.3±54.3)mL和(135.5±48.0)mL、(31.3±13.1)min和(21.8±10.5)min、(11.6±4.2)d和(15.1±3.5)d,2组比较差异有统计学意义(P＜0.05).RLPN组1例因术中出血影响手术视野,转为开放手术.RLPN组中3例需要输血(9.4%),OPN组中2例需要输血(5.7%),2组比较差异无统计学意义(P＞0.05).手术切缘均为阴性.术后随访4~86个月,RLPN组复发1例(3.1%),OPN组复发2例(5.7%),2组比较差异无统计学意义(P＞ 0.05).结论 RLPN与OPN的手术治疗效果相同,RLPN优势是患者术后恢复快,但此技术难度相对较大,对有经验的手术医生而言,可作为治疗小肾癌的首选方式.