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目的:评价经腹腔入路与后腹腔入路两种途径腹腔镜肾部分切除术治疗T1a期肾癌的技术特点及临床效果。方法:回顾性比较分析35例经腹腔入路(A组)与33例后腹腔入路(B组)腹腔镜肾部分切除术治疗T1a期肾癌患者的临床资料,对两组肿瘤大小、标本重量、性别、年龄、手术时间、术中出血量、热缺血时间、术后肠功能恢复时间、术后住院天数、围手术期并发症等指标进行对比研究。两组共68例患者均获得随访,比较两种术式的肿瘤学效果。结果:两组在肿瘤大小、标本重量、性别、年龄、手术时间、术中出血量、热缺血时间、围手术期并发症发生率、术后无瘤生存率等方面均无明显差异(P>0.05);B组在术后肠功能恢复时间及术后住院天数小于A组(P<0.05)。结论:对于治疗T1a期肾癌,两种途径的腹腔镜手术效果相似。后腹腔入路腹腔镜肾部分切除术对肠道干扰少,可缩短术后肠功能恢复时间及术后住院天数。本中心采用“三步走”方法-剪刀剪除肿瘤、双极电凝止血、Hem-o-lok结扎夹辅助8字缝合,安全、高效、可靠。肌苷、甘露醇及利尿剂使用可减少缺血再灌注损伤,保护肾功能。
Objective: To evaluate the technical characteristics and clinical effects of laparoscopic partial nephrectomy for T1a stage renal carcinoma both by transperitoneal approach and retroperitoneal approach. Methods: The clinical data of 35 patients with T1a renal cell carcinoma treated by peritoneal approach (group A) and 33 patients underwent retroperitoneal approach (group B) were analyzed retrospectively. The tumor size, Weight, sex, age, operation time, intraoperative blood loss, warm ischemia time, postoperative intestinal function recovery time, postoperative hospital stay, perioperative complications and other indicators were compared. A total of 68 patients in both groups were followed up and the oncological effects of the two procedures were compared. Results: There was no significant difference in tumor size, specimen weight, sex, age, operation time, intraoperative blood loss, warm ischemia time, perioperative complications and postoperative tumor-free survival rate > 0.05). The recovery time of intestinal function and postoperative hospital stay in group B were less than those in group A (P <0.05). Conclusions: Laparoscopic procedures for both approaches are similar for the treatment of T1a renal cell carcinoma. Retroperitoneal laparoscopic partial nephrectomy on the intestinal disturbance less, can shorten the recovery time of intestinal function and postoperative hospital days. The center adopts “three-step” method - scissors to remove the tumor, bipolar coagulation hemostasis, Hem-o-lok ligation clip aids 8-suture, safe, efficient and reliable. Inosine, mannitol and diuretic use can reduce ischemia-reperfusion injury and protect renal function.