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目的:通过比较侧腹入路、经腹入路和后腹入路三种入路行腹腔镜肾部分切除术(LPN)的优缺点,来研究侧腹入路行LPN治疗肾癌的有效性及安全性。方法:我们回顾分析2011年1月~2013年12月我院行LPN的126例肾肿瘤患者的临床资料,其中42例侧腹入路、38例经腹入路和46例后腹入路(肿瘤直径≤4cm),比较三种入路行LPN的手术及术后指标。结果:侧腹入路组42例患者手术均获成功,平均手术时间(96±25)min,平均术中出血量(157±83)ml,平均住院时间(7.0±2.5)d,与其他两种入路相比均明显减少(P<0.05)。侧腹入路组术中没有出现周围脏器损伤等严重并发症,无大出血,无患者输血。术后48h患者下床活动,术后平均住院时间7d。术后随访6~48个月,无一例复发或转移。结论:侧腹入路结合了经腹入路和后腹入路的优点,显露和阻断肾动脉更容易、更清晰;同时在处理肿瘤位于肾脏中上极腹侧面时,操作空间更大、创面缝合更容易。侧腹入路开创了LPN的新入路。
OBJECTIVE: To compare the advantages and disadvantages of laparoscopic partial nephrectomy (LPN) by comparing the lateral approach, transabdominal approach and retro-abdominal approach to study the effectiveness of LPN in the treatment of renal cell carcinoma And safety. METHODS: We retrospectively analyzed the clinical data of 126 renal cancer patients from our hospital from January 2011 to December 2013, including 42 cases of lateral approach, 38 cases of transabdominal approach and 46 cases of retroperitoneal approach Tumor diameter ≤ 4cm), compared the three methods of LPN surgery and postoperative indicators. Results: Forty-two patients underwent lateral operation successfully. The average operation time (96 ± 25) min, mean operative blood loss (157 ± 83) ml and average length of hospital stay (7.0 ± 2.5) days were the same as the other two The pathways were significantly reduced (P <0.05). Lateral approach group surgery did not appear serious complications such as organ damage, no major bleeding, no blood transfusions. 48h after surgery patients get out of bed, the average postoperative hospital stay 7d. All cases were followed up for 6 to 48 months without any recurrence or metastasis. Conclusion: The lateral approach combines the advantages of transabdominal approach and posterior approach, exposing and blocking the renal artery is easier and clearer. At the same time, the space for operation is larger when the tumor is located in the upper pole of the kidney, Suture wound easier. The ventral approach opens up a new path to LPN.