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目的:评价与比较高海拔地区后腹腔镜与开放性根治性肾切除术治疗肾癌的临床价值。方法:回顾性分析我院泌尿外科2006年10月～2012年6月手术治疗的肾癌76例进行对比分析,其中后腹腔镜肾癌根治术40例,开放性肾癌根治术36例,分别设为A组和B组,根据平均手术时间、术中平均出血量、肠功能平均恢复时间、术后住院时间、术后并发症及术前术后肝肾功能及心肌酶谱等生化结果的影响情况等临床资料对两组手术进行统计分析。结果:两组手术均获得成功,术后病理均证实为肾细胞癌。除手术时间差异无统计学意义(P>0.05),A组术中平均出血量、肠功能平均恢复时间、术后住院时间均明显少于B组,差异有统计学意义(P<0.05);生化结果变化情况:A组与术前相比,术后1天肝、肾功能指标及心肌酶均有不同程度的增高,术后3天恢复至术前水平,术前后肝、肾功能及心肌酶谱差异无统计学意义(P>0.05),B组术前术后均无显著性差异。结论:在高海拔地区后腹腔镜人工CO2气腹对肝、肾功能及心肌酶谱无明显影响,对于术前心肝肾功能正常的患者不至于造成严重损伤,与开放性手术相比,后腹腔镜手术治疗肾癌具有创伤小、术中出血量少、术后肠功能恢复快、术后住院时间短等优点,值得临床推广。
Objective: To evaluate and compare the clinical value of retroperitoneoscopic and open radical nephrectomy in the treatment of renal cell carcinoma at high altitude. Methods: A retrospective analysis of urological surgery in our hospital from October 2006 to June 2012 76 cases of renal cell carcinoma were compared, including 40 cases of retroperitoneal radical nephrectomy, open radical nephrectomy in 36 cases, respectively According to the average operation time, intraoperative average blood loss, average recovery time of intestinal function, postoperative hospital stay, postoperative complications and preoperative and postoperative liver and kidney function and myocardial enzymes and other biochemical results Impact and other clinical data on the two groups of surgery for statistical analysis. Results: All the two surgeries were successful. Renal cell carcinoma was confirmed by pathology. The mean intraoperative blood loss, mean recovery time of intestinal function and postoperative hospital stay in group A were significantly lower than those in group B (P <0.05), except for the difference in operative time (P> 0.05). Changes in biochemical results: Group A compared with preoperative, liver and kidney function indexes and myocardial enzymes increased to varying degrees 1 day after surgery, returned to preoperative level 3 days after surgery, preoperative and postoperative liver and kidney function and There was no significant difference in myocardial enzymes (P> 0.05), but there was no significant difference in group B before and after operation. CONCLUSION: Retroperitoneal laparoscopic artificial pneumoperitoneum has no significant effect on liver and renal function and myocardial zymogram in high altitude area, but does not cause serious damage to patients with normal liver, liver and kidney function before operation. Compared with open surgery, Laparoscopic surgery for the treatment of renal cell carcinoma with less trauma, less blood loss, postoperative recovery of intestinal function quickly, shorter postoperative hospital stay, etc., worthy of clinical promotion.