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目的对比分析开放与后腹腔镜肾部分切除术治疗早期肾癌的安全性与疗效。方法总结2004年12月至2010年2月我中心60例肾癌肾部分切除术,其中开放手术19例,男∶女=17∶2;后腹腔镜手术41例,男∶女=33∶8。对比两组患者基本资料及围手术期相关数据,所有患者肾癌临床分期均为T1N0M0,术后病理证实透明细胞癌54例,乳头状肾细胞癌6例。结果所有手术均获成功,开放组与后腹腔镜组患者年龄分别为(57.7±17.7)岁vs(55.2±16.6)岁(P=0.607);肿瘤直径为(3.3±0.9)cmvs(2.9±1.0)cm(P=0.063);术前肌酐为(107.9±54.7)μmol/Lvs(96.8±18.2)μmol/L(P=0.396);术后肌酐为(117.8±55.9)μmol/Lvs(107.5±19.6)μmol/L(P=0.443);手术前后肌酐变化分别为(9.8±22.2)μmol/L和(9.8±14.3)μmol/L(P=0.988);两组手术时间为(167.9±46.9)minvs(148.5±41.2)min(P=0.108);肾动脉阻断时间为(21.6±10.2)minvs(26.9±9.0)min(P=0.058);术中失血量为(327.9±174.2)mlvs(181.8±120.1)ml(P=0.247);术后住院时间为(11.0±3.4)dvs(8.9±4.0)d(P=0.015)。开放组与后腹腔镜组术后输血患者分别为3例和4例(P=0.668),出现术后并发症的患者分别为2例和3例(P=0.648)。两组患者分别随访38.8及45.4个月,肿瘤控制良好,两组患者末次随访肾功能差异无统计学意义。结论后腹腔镜肾部分切除术在治疗早期肾肿瘤方面,安全性及疗效与开放手术相似,而手术创伤小、恢复速度快。
Objective To compare the safety and efficacy of open and retroperitoneoscopic partial nephrectomy in the treatment of early stage renal cell carcinoma. Methods From December 2004 to February 2010, 60 cases of partial nephrectomized renal cell resection were performed in our center. There were 19 cases of open surgery, male and female = 17: 2, and 41 cases of retroperitoneal laparoscopic surgery, male and female = 33: 8 . Comparing the basic data and perioperative data, the clinical stage of renal cell carcinoma in all patients was T1N0M0. The pathological examination confirmed 54 cases of clear cell carcinoma and 6 cases of papillary renal cell carcinoma. Results All surgeries were successful. The age of the patients in the open group and the retroperitoneal laparoscopic group was (57.7 ± 17.7) years vs 55.2 ± 16.6 years (P = 0.607), and the tumor diameter was (3.3 ± 0.9) cm vs (2.9 ± 1.0) ) (P = 0.063). The preoperative creatinine was (107.9 ± 54.7) μmol / L vs 96.8 ± 18.2 μmol / L and the creatinine was (117.8 ± 55.9) μmol / L vs 107.5 ± 19.6 ), creatinine (9.8 ± 22.2) μmol / L and (9.8 ± 14.3) μmol / L respectively before and after surgery (P = 0.883); The operative time was (167.9 ± 46.9) (148.5 ± 41.2) min (P = 0.108). The time of renal artery occlusion was (21.6 ± 10.2) min vs (26.9 ± 9.0) min 120.1) ml (P = 0.247). The postoperative hospital stay was (11.0 ± 3.4) d vs (8.9 ± 4.0) days (P = 0.015). There were 3 cases and 4 cases of transfusions after open laparoscopic and open laparoscopic surgery respectively (P = 0.668). There were 2 cases and 3 cases of postoperative complications (P = 0.648). Two groups of patients were followed up for 38.8 and 45.4 months, the tumor was well controlled, the two groups were no difference in renal function between the last follow-up. Conclusions Retroperitoneal laparoscopic partial nephrectomy in the treatment of early renal tumors, safety and efficacy similar to the open surgery, and surgical trauma, fast recovery.