腹腔镜肾癌根治术与开放性肾癌根治术治疗T1期肾癌的疗效比较
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摘要
目的对比腹腔镜肾癌根治术与开放性肾癌根治术治疗T1期肾癌的临床疗效。方法选择2014年1月至2017年6月泌尿外科收治的136例肾癌患者为研究对象,根据随机数字表法分为两组,每组68例,对照组予开放性肾癌根治术治疗,观察组予腹腔镜下肾癌根治术治疗,比较两组临床疗效指标,以及术后肾功能、血清C反应蛋白(CRP)、皮质醇(Cor)、丙二醛(MDA)的变化。结果观察组患者术中出血量、肠道功能恢复时间及住院时间分别为(76.2±21.8)mL、(2.2±0.6)d、(7.1±2.0)d,均明显少于对照组的(150.9±40.7)mL、(3.1±0.9)d、(11.3±3.4)d,差异有统计学意义(P<0.05);术后,两组患者血肌酐及尿素氮比较,差异无统计学意义(P>0.05);观察组血清CRP水平为(13.9±3.8)mg/L,Cor为(242.7±50.3)ng/mL,MDA为(6.7±2.1)ng/mL,均明显低于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为5.88%,明显低于对照组的20.59%,差异有统计学意义(P<0.05)。结论腹腔镜肾癌根治术与开放性手术比较,具有创伤小、应激反应轻、出血量少、术后恢复快等微创的优势。
Objective To compare the clinical efficacies of laparoscopy and open radical operation for treating stage T1 renal carcinoma.Methods One hundred and thirty-six cases of renal carcinoma in the urologic surgery department of this hospital from January 2014 to June 2017 were selected as the research subjects and divided into the two groups according to the random number method,68 cases in each group.The control group was treated by open renal cancer radical operation,while the observation group was given retroperitoneal laparoscopic renal cancer radical operation.The clinical efficacy indexes,postoperative renal function and serum CRP,Cor and MDA changes were compared between the two groups.Results The intraoperative bleeding volume,intestinal function recovery and hospitalization time in the observation group were(76.2±21.8)mL,(2.2±0.6)d and(7.1±2.0)d,which were significantly less than(150.9±40.7)mL,(3.1±0.9)d and(11.3±3.4)d in the control group,the difference was statistically significant(P<0.05);after surgery,serum creatinine and urea nitrogen had no statistically significant difference between the two groups(P>0.05);the serum CRP,Cor and MDA in the observation group was(13.9±3.8)mg/L,(242.7±50.3)ng/mL and(6.7±2.1)ng/mL,which were significantly lower than those in the control group,the difference was statistically significant(P<0.05);the occurrence rate of complications in the observation group was 5.88%,which was significantly lower than 20.59% in the control group,the difference was statistically significant(P<0.05).Conclusion Compared with open surgery,laparoscopic renal cancer radical operation has the advantages of small trauma,slight stress response,less bleeding and quick postoperative recovery.
Objective To compare the clinical efficacies of laparoscopy and open radical operation for treating stage T1 renal carcinoma.Methods One hundred and thirty-six cases of renal carcinoma in the urologic surgery department of this hospital from January 2014 to June 2017 were selected as the research subjects and divided into the two groups according to the random number method,68 cases in each group.The control group was treated by open renal cancer radical operation,while the observation group was given retroperitoneal laparoscopic renal cancer radical operation.The clinical efficacy indexes,postoperative renal function and serum CRP,Cor and MDA changes were compared between the two groups.Results The intraoperative bleeding volume,intestinal function recovery and hospitalization time in the observation group were(76.2±21.8)mL,(2.2±0.6)d and(7.1±2.0)d,which were significantly less than(150.9±40.7)mL,(3.1±0.9)d and(11.3±3.4)d in the control group,the difference was statistically significant(P<0.05);after surgery,serum creatinine and urea nitrogen had no statistically significant difference between the two groups(P>0.05);the serum CRP,Cor and MDA in the observation group was(13.9±3.8)mg/L,(242.7±50.3)ng/mL and(6.7±2.1)ng/mL,which were significantly lower than those in the control group,the difference was statistically significant(P<0.05);the occurrence rate of complications in the observation group was 5.88%,which was significantly lower than 20.59% in the control group,the difference was statistically significant(P<0.05).Conclusion Compared with open surgery,laparoscopic renal cancer radical operation has the advantages of small trauma,slight stress response,less bleeding and quick postoperative recovery.
引文
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[11]张雄文,韦雪云.腹腔镜胆囊切除术患者围术期氧化应激及血液黏滞度指标的变化[J].实用临床医药杂志,2013,17(13):30-32.
[2]唐贤富.腹腔镜下和开放性肾癌根治术对肾癌的效果,并发症及生存率的影响[J].中国医药导报,2017,14(35):79-81.
[3]方冬,李学松,谌诚,等.经腹腔与腹膜后腹腔镜肾癌根治术疗效比较[J].现代泌尿外科杂志,2013,18(2):126-129.
[4]张涛,于德新,张志强,等.局限性肾癌患者腹腔镜手术前后生活质量初步调查分析[J].安徽医科大学学报,2015,50(6):833-836.
[5]胡骁轶,陈惠新,王国民,等.T1期肾癌保留肾单位手术(NSS)的临床研究[J].复旦学报(医学版),2014,41(6):855-857.
[6]和学强.局限性肾癌后腹腔镜肾癌根治术的应用效果观察[J].海南医学,2014,25(10):1502-1503.
[7]徐维锋,李汉忠,纪志刚,等.不同入路腹腔镜手术治疗大体积肾癌的对照研究[J].中华泌尿外科杂志,2014,35(9):645-649.
[8]陈健,康新立,王为服,等.后腹腔镜下肾癌根治术18例临床观察[J].海南医学,2010,21(18):16-18.
[9]肖卫忠,陈勇,潘森,等.经腹膜与腹膜后腹腔镜下肾部分切除术疗效和安全性比较的Meta分析[J/CD].中华临床医师杂志(电子版),2016,10(8):1146-1151.
[10]FAN X X,XU K W,LIN T X,et al.Comparison of transperitoneal and retroperitoneal laparoscopic nephrectomy for renal cell carcinoma:a systematic review and meta-analysis[J].BJU Int,2013,111(4):611-621.
[11]张雄文,韦雪云.腹腔镜胆囊切除术患者围术期氧化应激及血液黏滞度指标的变化[J].实用临床医药杂志,2013,17(13):30-32.