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目的评估比较开放性保留肾单位肾切除术与腹腔镜保留肾单位肾切除术治疗局限性肾细胞癌的临床效果。方法回顾性分析自2007-06/2013-10月因肾细胞癌于作者医院行保留肾单位手术治疗的131例患者的临床资料。其中86例行开放性保留肾单位肾切除术(open partial nephrectomy,OPN)治疗,45例行腹腔镜保留肾单位肾切除术(laparoscopic partial nephrectomy,LPN)治疗。对两组病例肿瘤大小、手术时间、肾脏热缺血时间、术中出血量、引流量、引流管留置时间、术后住院时间、术后并发症、术前及术后肌酐及术后复发等指标进行回顾性分析。结果 OPN组与LPN组的基本情况以及并发症发生率,无统计学差异(P>0.05)。LPN动脉阻断时间较OPN组长(P=0.01),但术时、出血量、输血例数、术后引流时间及住院时间均较少于后者(P<0.05)。两组术后肌酐较术前均有升高。随访124例病人,平均随访26个月(1~76个月),OPN组有1例术后第4年死于肾癌腹腔转移,1例术后5年死于前列腺癌,1例术后15月中下腹及肾门转移;LPN组未见复发及转移。结论 LPN较OPN相比具有创伤小、出血少、恢复快、住院时间短等优点,且能达到OPN的治疗效果。在熟练掌握腹腔镜下操作及缝合等手术技巧的前提下,腹腔镜肾部分切除术是治疗局限性肾癌的一种更好的手段。
Objective To evaluate the clinical effect of open nephron nephrectomy and laparoscopic nephron nephrectomy for the treatment of localized renal cell carcinoma. Methods The clinical data of 131 patients with renal cell carcinoma treated by renal cell carcinoma in the author hospital since 2007-06 / 2013-10 were retrospectively analyzed. Among them, 86 cases were treated with open partial nephrectomy (OPN) and 45 cases were treated with laparoscopic partial nephrectomy (LPN). Tumor size, operation time, renal ischemia time, intraoperative blood loss, drainage, drainage tube indwelling time, postoperative hospital stay, postoperative complications, preoperative and postoperative creatinine and postoperative recurrence were compared between the two groups Retrospective analysis of indicators. Results There was no significant difference between the OPN group and the LPN group (P> 0.05). The LPN occlusion time was longer than that of OPN group (P = 0.01). However, the amount of blood loss, blood transfusion, postoperative drainage time and hospital stay were less than those of OPN group (P <0.05). Postoperative creatinine in both groups was higher than that before operation. A total of 124 patients were followed up for an average of 26 months (ranging from 1 to 76 months). One patient in the OPN group died of metastatic renal cell carcinoma in the fourth year after operation, one died of prostate cancer at 5 years after operation, Mid-lower abdomen and renal portal metastasis in 15 months; no recurrence and metastasis in LPN group. Conclusion Compared with OPN, LPN has the advantages of less trauma, less bleeding, faster recovery and shorter hospital stay, and can achieve the therapeutic effect of OPN. Laparoscopic partial nephrectomy is a better way to treat localized renal cell carcinoma under the premise of mastery of surgical techniques such as laparoscopic operation and suturing.