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目的:评价经腹腹腔镜和后腹腔镜肾切除手术与开放肾根治性切除术的临床价值。方法:回顾分析我院自2011年11月~2014年4月病例资料,对32例经腹腹腔镜肾切除术、115例后腹腔镜肾切除手术和43例开放肾切除手术的临床资料进行比较,统计分析三种术式在手术操作时间、术中平均出血量、输血例数、腹腔引流管留置时间、术后住院时间和术后并发症等方面的差异。结果:经腹腹腔镜肾根治性切除术32例因术中大出血转开放手术2例,其余30全部成功;后腹腔镜手术115例除1例因后腹腔广泛粘连改开放手术外,其余114例成功;43例开放手术均获成功。三组手术时间分别为(153.5±47.4)min、(135.5±34.2)min和(121.8±30.3)min,经腹腹腔镜组和后腹腔镜组手术时间差异无统计学意义,两组手术时间均高于开放手术组(P=0.007,P=0.049)。三组术中出血量分别为(102.7±38.1)ml、(125.1±53.5)ml和(190±79.3)ml,三组比较差异均有统计学意义,经腹腹腔镜组术中出血低于后腹腔镜组(P=0.033),并显著低于开放手术组(P<0.001),后腹腔镜组术中出血显著低于开放手术组(P<0.001)。输血例数分别为7例、11例和5例,三组比较差异无统计学意义(P=0.13)。腹腔引流管留置时间分别为(6.5±2.9)d、(5.3±2.6)d和(5.7±1.5)d,三组比较差异无统计学意义(P=0.053)。三组术后住院时间分别为(10.5±4.1)d、(10.2±3.8)d和(12.6±3.1)d,经腹腹腔镜组和后腹腔镜组术后住院时间明显低于开放手术组(P=0.017,P<0.001)。经腹腹腔镜组术中无并发症,后腹腔镜组术中出现皮下气肿2例;开放手术组术中未发生并发症,术后1例因伤口感染愈合不佳。结论:经腹腹腔镜和后腹腔镜肾切除术在术中出血量和术后恢复等方面明显优于开放手术,开放手术所需时间较经腹腹腔镜和后腹腔镜肾切除术明显缩短,后腹腔入路虽技术难度较大,但手术效果优于经腹入路。
Objective: To evaluate the clinical value of transabdominal and retroperitoneal laparoscopic nephrectomy and open radical nephrectomy. Methods: The data of our hospital from November 2011 to April 2014 were retrospectively analyzed. The clinical data of 32 cases of laparoscopic nephrectomy, 115 cases of laparoscopic nephrectomy and 43 cases of open nephrectomy were compared , Statistical analysis of three surgical procedures in the operation time, intraoperative blood loss, blood transfusion cases, abdominal drainage tube indwelling time, postoperative hospital stay and postoperative complications and other differences. Results: Laparoscopic radical nephrectomy in 32 cases due to intraoperative hemorrhage turned open surgery in 2 cases, the remaining 30 all successful; retroperitoneal laparoscopic surgery in 115 cases except for 1 case due to extensive peritoneal adhesions to open surgery, the remaining 114 cases Successful; 43 cases of open surgery were successful. The operative time of the three groups were (153.5 ± 47.4) min, (135.5 ± 34.2) min and (121.8 ± 30.3) min, respectively. There was no significant difference in operative time between the laparoscopic group and the retroperitoneal laparoscopic group. The operative time Higher than the open surgery group (P = 0.007, P = 0.049). The bleeding volume in the three groups was (102.7 ± 38.1) ml, (125.1 ± 53.5) ml and (190 ± 79.3) ml, respectively, with significant difference between the three groups Laparoscopic group (P = 0.033), which was significantly lower than that of open surgery group (P <0.001) .Postoperative laparoscopic group bleeding was significantly lower than that of open surgery group (P <0.001). Blood transfusion cases were 7 cases, 11 cases and 5 cases, the difference was not statistically significant (P = 0.13). The placement time of peritoneal drainage tube were (6.5 ± 2.9) days, (5.3 ± 2.6) days and (5.7 ± 1.5) days, respectively. There was no significant difference between the three groups (P = 0.053). The postoperative hospital stay in the three groups were (10.5 ± 4.1) days, (10.2 ± 3.8) days and (12.6 ± 3.1) days, respectively. The postoperative hospital stay was significantly lower in the laparoscopic and laparoscopic groups than in the open surgery group P = 0.017, P <0.001). There were no complications in the laparoscopic surgery group and 2 cases of subcutaneous emphysema in the laparoscopic surgery group. No complications occurred in the open surgery group, and 1 patient had poor wound healing after operation. Conclusions: Laparoscopic and retroperitoneal laparoscopic nephrectomy is superior to open surgery in terms of intraoperative blood loss and postoperative recovery. The time required for open surgery is significantly shorter than that of laparoscopic and retroperitoneal laparoscopic nephrectomy. Posterior abdominal approach although the technical difficulty, but the surgeries are better than the transabdominal approach.