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目的:判断腹膜后镜根治性肾切除术对于平均直径7cm肾癌的临床治疗价值。方法:回顾性分析36例2002年1月~2006年7月行腹膜后镜根治性肾切除术患者的资料,并与同期46例行开放根治性肾切除术患者的临床资料进行比较。腹膜后镜组肿瘤直径为4~9(7.4±1.5)cm,开放组为4~10(7.6±1.2)cm(P>0.01)。所有患者术后病理均证实为肾细胞癌。结果:腹膜后镜治疗组与开放治疗组的手术时间分别为80~220(172±35)min,60~190(165±40)min(P>0.01);术中出血量两组分别为40~300(210±30)ml,50~450(410±100)ml(P<0.01);术后进普食天数两组分别为3~8(3.9±1.0)天,5~11(7.4±2.0)天(P<0.01);术后平均住院日两组分别为5~8(7.0±1.3)天,7~13(8.5±1.8)天(P<0.01)。所有患者平均随访27(9~50)个月,随访期间均未出现手术切口种植转移。结论:腹膜后镜根治性肾切除术具有创伤小,出血少,术后恢复快的优点,随访中发现两种治疗方式对于患者短期的生存率没有影响。对于直径4~10cm肾肿瘤,腹膜后镜根治性肾切除术可以取代开放根治性肾切除术。
Objective: To determine the value of retroperitoneal radical nephrectomy for the treatment of renal carcinoma with an average diameter of 7cm. Methods: The clinical data of 36 patients who underwent radical retroperitoneal radical nephrectomy from January 2002 to July 2006 were analyzed retrospectively. The clinical data of 46 patients undergoing open radical nephrectomy were compared. The diameter of the tumor in the retroperitoneal mirror group was 4 to 9 (7.4 ± 1.5) cm and in the open group was 4 to 10 (7.6 ± 1.2) cm (P> 0.01). Postoperative pathology of all patients confirmed renal cell carcinoma. Results: The operative time was 80 ~ 220 (172 ± 35) min and 60 ~ 190 (165 ± 40) min (P> 0.01) respectively in the group of the retroperitoneal mirror and the open treatment group. The amount of bleeding during the operation was 40 (3.9 ± 1.0) days and 5 ~ 11 (7.4 ± 2) days respectively in the two groups (P <0.01) 2.0) days (P <0.01). The average postoperative hospital stay was 5-8 (7.0 ± 1.3) days and 7-13 (8.5 ± 1.8) days respectively (P <0.01). All patients were followed up for an average of 27 (9-50) months. No surgical incision metastasis was observed during follow-up. Conclusions: Retroperitoneoscopic radical nephrectomy has the advantages of less trauma, less bleeding and faster recovery after operation. Both treatment methods have no effect on the short-term survival rate of patients. For 4 ~ 10cm in diameter of renal tumors, retroperitoneal radical nephrectomy can replace open radical nephrectomy.