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目的:评价后腹腔入路与经腹入路腹腔镜下肾部分切除术治疗早期肾癌的临床效果。方法:回顾性分析后腹腔入路(17例,A组)与经腹入路(15例,B组)腹腔镜下肾部分切除术治疗早期肾癌患者的临床资料,A组肿瘤大小1.2～3.9(2.6±1.3)cm,B组肿瘤大小1.0～4.0(2.7±1.3)cm。两组术前临床分期均为T_1N_0M_0。比较两种方法的肿瘤大小、手术时间、术中失血量、热缺血时间、标本重量、恢复进食时间、住院时间及手术效果。结果:A组手术均成功,B组1例因肾动脉损伤出血中转开放手术。两组肿瘤大小(2.6±1.3 cm vs 2.7±1.3cm)、术中失血量(302±85mlvs305±90ml)、标本重量(42±31g vs 45±33 g)、热缺血时间(28±9.1 min vs30±9.2min)等方面无明显差异(P>0.05);A组在手术时间(175±55 min vs 248±70 min)、恢复进食时间(24±5 h vs 49±11 h)和住院时间(6.5±1.6天vs 8.4±1.9天)均少于B组(P<0.05)。结论:后腹腔入路与经腹入路腹腔镜下肾部分切除术均是治疗早期肾癌的一种微创和安全有效的治疗方法,后腹腔入路在手术时间、恢复进食时间及住院时间上少于经腹入路。
Objective: To evaluate the clinical effect of retroperitoneal and laparoscopic partial nephrectomy in the treatment of early stage renal cell carcinoma. Methods: The clinical data of laparoscopic partial nephrectomy in patients with early stage renal cell carcinoma underwent retroperitoneal approach (group A, 17 cases) and transabdominal approach (group 15, group B) were retrospectively analyzed. The tumor size of group A was 1.2 ~ 3.9 (2.6 ± 1.3) cm in group B. The size of tumor in group B was 1.0-4.0 (2.7 ± 1.3) cm. Preoperative clinical stage of both groups were T_1N_0M_0. The tumor size, operative time, intraoperative blood loss, warm ischemia time, specimen weight, recovery time to eat, hospital stay and operative effect were compared between the two methods. Results: All the patients in group A were successful in operation. One patient in group B underwent open surgery because of hemorrhage of renal artery. The mean tumor size was 2.6 ± 1.3 cm vs 2.7 ± 1.3 cm in the two groups. The intraoperative blood loss (302 ± 85 ml vs 305 ± 90 ml), the specimen weight (42 ± 31 g vs 45 ± 33 g), the warm ischemia time (28 ± 9.1 min) (30 ± 9.2 min vs30 ± 9.2 min). There was no significant difference between the two groups in the time of operation (175 ± 55 min vs 248 ± 70 min), recovery time (24 ± 5 h vs 49 ± 11 h) and hospital stay (6.5 ± 1.6 days vs 8.4 ± 1.9 days) were less than those in group B (P <0.05). Conclusions: The retroperitoneal approach and laparoscopic partial nephrectomy are both a minimally invasive and safe treatment for early stage renal cell carcinoma. The posterior abdominal approach has the advantages in operation time, recovery time and hospital stay On the less than the abdominal approach.