层面外科在经腹入路腹腔镜下大体积肾癌根治术中的应用效果
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摘要
目的探讨层面外科在经腹入路腹腔镜下大体积肾癌根治术中的应用效果。方法选取我院2014年1月～2018年11月收治的56例大体积肾癌作为研究对象。按随机数字表法将其分为A组(28例)与B组(28例)。A组施行开放经腹腔入路肾癌根治术,B组施行层面外科经腹入路腹腔镜下肾癌根治术。比较两组患者的术中出血量、手术时间、术后住院时间、术后下床活动时间、术后肠道功能恢复时间、视觉模拟评分法(VAS)疼痛评分及术后拔除腹腔引流管时间、输血率及并发症总发生率等。结果 B组患者的术中出血量少于A组,手术时间、术后住院时间、术后下床活动时间、术后肠道功能恢复时间及术后拔除腹腔引流管时间短于A组,VAS评分低于A组,差异均有统计学意义(P<0.001);B组患者的输血率、术中并发症和术后并发症总发生率低于A组,满意度高于A组,差异均有统计学意义(P<0.05)。结论层面外科在经腹入路腹腔镜下大体积肾癌根治术中的应用是安全有效的,术中循天然无血管、少脂肪和多层次的解剖外科层面进行游离,出血少,输血率低,术中和术后并发症少,以及术后恢复快、患者满意度高,值得临床推广和应用。
Objective To investigate the application effect of trans-interfascial plane surgery in radical nephrectomy for large volume renal carcinoma under transabdominal laparoscope. Methods From January 2014 to November 2018,56 patients with large volume renal carcinoma treated in our hospital were selected as the study subjects. They were divided into group A(28 cases) and group B(28 cases) by the random number table method. Group A was given open transperitoneal radical nephrectomy for renal cancer, while group B was given trans-inaterfascial plane surgery for laparoscopic radical nephrectomy by transabdominal approach. The intraoperative blood loss, operation time, postoperative hospital stay, time to get out of bed after operation, postoperative intestinal function recovery time, visual analogue scale(VAS) pain score, postoperative removal of abdominal drainage tube, blood transfusion rate and total incidence of complication were compared in patients between the two groups. Results The intraoperative blood loss in group B were less than that in group A, and the operative time, postoperative hospital stay, time to get out of bed after operation,postoperative intestinal function recovery time, and postoperative removal of abdominal drainage tube in group B were shorter than those of group A, and VAS score was lower than that in group A, and the differences were statistically significant between the two groups(P<0.001). The blood transfusion rate, the total incidence of intraoperative complications and postoperative complications in group B were lower than those in group A, and the satisfaction degree was higher than that in group A, with statistical significances(P<0.05). Conclusion The application of trans-inaterfascial plane surgery in large volume renal carcinoma with laparoscopic radical nephrectomy by transabdominal approach is safe and effective. It is dissociated by following natural avascular, less fat and multi-level anatomical surgical layers during the operation, which has less bleeding, low blood transfusion rate, few intraoperative and postoperative complications, as well as rapid postoperative recovery and high patients′ satisfaction degree. It is worthy of clinical application and promotion.
Objective To investigate the application effect of trans-interfascial plane surgery in radical nephrectomy for large volume renal carcinoma under transabdominal laparoscope. Methods From January 2014 to November 2018,56 patients with large volume renal carcinoma treated in our hospital were selected as the study subjects. They were divided into group A(28 cases) and group B(28 cases) by the random number table method. Group A was given open transperitoneal radical nephrectomy for renal cancer, while group B was given trans-inaterfascial plane surgery for laparoscopic radical nephrectomy by transabdominal approach. The intraoperative blood loss, operation time, postoperative hospital stay, time to get out of bed after operation, postoperative intestinal function recovery time, visual analogue scale(VAS) pain score, postoperative removal of abdominal drainage tube, blood transfusion rate and total incidence of complication were compared in patients between the two groups. Results The intraoperative blood loss in group B were less than that in group A, and the operative time, postoperative hospital stay, time to get out of bed after operation,postoperative intestinal function recovery time, and postoperative removal of abdominal drainage tube in group B were shorter than those of group A, and VAS score was lower than that in group A, and the differences were statistically significant between the two groups(P<0.001). The blood transfusion rate, the total incidence of intraoperative complications and postoperative complications in group B were lower than those in group A, and the satisfaction degree was higher than that in group A, with statistical significances(P<0.05). Conclusion The application of trans-inaterfascial plane surgery in large volume renal carcinoma with laparoscopic radical nephrectomy by transabdominal approach is safe and effective. It is dissociated by following natural avascular, less fat and multi-level anatomical surgical layers during the operation, which has less bleeding, low blood transfusion rate, few intraoperative and postoperative complications, as well as rapid postoperative recovery and high patients′ satisfaction degree. It is worthy of clinical application and promotion.
引文
[1]Ning YY,Retnagowri R,Keng LN,et al.Genetic and chromosomal aberrations and their clinical significance in renal neoplasms[J].Biomed Res Int,2015,2015(1):476 508.
[2]Zhu X,Yang X,Hu X,et al.Retroperitoneoscopic versus open surgical radical nephrectomy for 152 Chinese patients with large renal cell carcinoma in clinical stage cT2 or cT3a:a long-term retrospective comparison[J].J Cancer Res Ther,2016,12(2):805-810.
[3]Yuan B,Wang Y,Gao J,et al.Lower pole approach in retroperitoneal laparoscopic radical nephrectomy:a new approach for the management of renal vascular pedicle[J].World J Surg Oncol,2018,16(1):31.
[4]Rosoff JS,Raman JD,Sosa RE,et al.Laparoscopic radical nephrectomy for renal masses 7 centimeters or larger[J].JSLS,2009,13(2):148-153.
[5]邱剑光,高新,朱建国,等.肾周腹膜后隙腔镜下解剖特征及其临床应用[J].中华泌尿外科杂志,2005,26(2):91-93.
[6]张雪培.泌尿外科腹腔镜手术图解[M].郑州:河南科学技术出版社,2014:52.
[7]梅傲冰,邱剑光,贾本忠,等.腹腔镜下肾前筋膜间平面的临床解剖学研究[J].中国临床解剖学杂志,2013,31(3):256-260.
[8]宗行万之助.疼痛的估价---用特殊的视觉模拟评分法作参考(VAS)[J].疼痛学杂志,1994,2(4):153.
[9]Bolton EM,Hennessy D,Lonergan PE,et al.Evaluating the perioperative safety of laparoscopic radical nephrectomy for large,non-metastatic renal tumours:a comparative analysis of T1-T2 with T3a tumours[J].Ir J Med Sci,2018,187(2):313-318.
[10]Liu TY,Li J,Wen XH,et al.The efficacy of open nephronsparing surgery in the treatment of complex renal cell carcinoma[J].Eur Rev Med Pharmacol Sci,2016,20(19):3959-3964.
[11]Laird A,Choy KC,Delaney H,et al.Matched pair analysis of laparoscopic versus open radical nephrectomy for the treatment of T3 renal cell carcinoma[J].World J Urol,2015,33(1):25-32.
[12]Kanno T,Kubota M,Sakamoto H,et al.Lapraoscopic radical nephrectomy for renal tumor>7 cm[J].Nihon Hinyokika Gakkai Zasshi,2016,107(1):1-6.
[13]Kim HY,Lee DS,Yoo JM,et al.Retroperitoneal laparoscopic radical nephrectomy for large(>7 cm)solid renal tumors:comparison of perioperative outcomes with the transperitoneal approach[J].J Laparoendosc Adv Surg Tech A,2017,27(4):393-397.
[14]Golombos DM,Chughtai B,Trinh QD,et al.Adoption of technology and its impact on nephrectomy outcomes,a U.Spopulation-based analysis(2008-2012)[J].J Endourol,2017,31(1):91-99.
[15]梅傲冰,孙旭,胡瑞洁,等.精准解剖式肾前筋膜间平面腹腔镜肾癌根治手术的要点分析[J].中华腔镜泌尿外科杂志(电子版),2018,12(4):266-269.
[16]Hakmin L,Chung UL,Jae HY,et al.Comparisons of oncological outcomes and perioperative complications between laparoscopic and open radical nephrectomies in patients with clinical T2 renal cell carcinoma(≥7 cm)[J].PLoS One,2018,13(1):e0191786.
[17]Kato H,Kiyokawa H,Inoue H,et al.Anatomical reconsideration to renal area:lessons learned from radical nephrectomy or adrenalectom y through a minimal incision over the12thrib[J].Int J Urol,2004,11(9):709-713.
[18]邱剑光.层面外科腹腔镜膀胱根治性切除术(附光盘)[J].现代泌尿外科杂志,2017,22(4):241-248.
[19]梅傲冰,邱剑光,贾本忠,等.肾前筋膜间平面无血腹腔镜上尿路手术入路精准解剖与技巧[J].中国临床解剖学杂志,2017,35(2):130-136.
[20]Se YK,Jae WJ,Bum SK,et al.Laparoscopic versus open radical nephrectomy in T2renal cell carcinoma:long-term oncologic outcomes[J].Korean J Urol,2011,52(7):474-478.
[2]Zhu X,Yang X,Hu X,et al.Retroperitoneoscopic versus open surgical radical nephrectomy for 152 Chinese patients with large renal cell carcinoma in clinical stage cT2 or cT3a:a long-term retrospective comparison[J].J Cancer Res Ther,2016,12(2):805-810.
[3]Yuan B,Wang Y,Gao J,et al.Lower pole approach in retroperitoneal laparoscopic radical nephrectomy:a new approach for the management of renal vascular pedicle[J].World J Surg Oncol,2018,16(1):31.
[4]Rosoff JS,Raman JD,Sosa RE,et al.Laparoscopic radical nephrectomy for renal masses 7 centimeters or larger[J].JSLS,2009,13(2):148-153.
[5]邱剑光,高新,朱建国,等.肾周腹膜后隙腔镜下解剖特征及其临床应用[J].中华泌尿外科杂志,2005,26(2):91-93.
[6]张雪培.泌尿外科腹腔镜手术图解[M].郑州:河南科学技术出版社,2014:52.
[7]梅傲冰,邱剑光,贾本忠,等.腹腔镜下肾前筋膜间平面的临床解剖学研究[J].中国临床解剖学杂志,2013,31(3):256-260.
[8]宗行万之助.疼痛的估价---用特殊的视觉模拟评分法作参考(VAS)[J].疼痛学杂志,1994,2(4):153.
[9]Bolton EM,Hennessy D,Lonergan PE,et al.Evaluating the perioperative safety of laparoscopic radical nephrectomy for large,non-metastatic renal tumours:a comparative analysis of T1-T2 with T3a tumours[J].Ir J Med Sci,2018,187(2):313-318.
[10]Liu TY,Li J,Wen XH,et al.The efficacy of open nephronsparing surgery in the treatment of complex renal cell carcinoma[J].Eur Rev Med Pharmacol Sci,2016,20(19):3959-3964.
[11]Laird A,Choy KC,Delaney H,et al.Matched pair analysis of laparoscopic versus open radical nephrectomy for the treatment of T3 renal cell carcinoma[J].World J Urol,2015,33(1):25-32.
[12]Kanno T,Kubota M,Sakamoto H,et al.Lapraoscopic radical nephrectomy for renal tumor>7 cm[J].Nihon Hinyokika Gakkai Zasshi,2016,107(1):1-6.
[13]Kim HY,Lee DS,Yoo JM,et al.Retroperitoneal laparoscopic radical nephrectomy for large(>7 cm)solid renal tumors:comparison of perioperative outcomes with the transperitoneal approach[J].J Laparoendosc Adv Surg Tech A,2017,27(4):393-397.
[14]Golombos DM,Chughtai B,Trinh QD,et al.Adoption of technology and its impact on nephrectomy outcomes,a U.Spopulation-based analysis(2008-2012)[J].J Endourol,2017,31(1):91-99.
[15]梅傲冰,孙旭,胡瑞洁,等.精准解剖式肾前筋膜间平面腹腔镜肾癌根治手术的要点分析[J].中华腔镜泌尿外科杂志(电子版),2018,12(4):266-269.
[16]Hakmin L,Chung UL,Jae HY,et al.Comparisons of oncological outcomes and perioperative complications between laparoscopic and open radical nephrectomies in patients with clinical T2 renal cell carcinoma(≥7 cm)[J].PLoS One,2018,13(1):e0191786.
[17]Kato H,Kiyokawa H,Inoue H,et al.Anatomical reconsideration to renal area:lessons learned from radical nephrectomy or adrenalectom y through a minimal incision over the12thrib[J].Int J Urol,2004,11(9):709-713.
[18]邱剑光.层面外科腹腔镜膀胱根治性切除术(附光盘)[J].现代泌尿外科杂志,2017,22(4):241-248.
[19]梅傲冰,邱剑光,贾本忠,等.肾前筋膜间平面无血腹腔镜上尿路手术入路精准解剖与技巧[J].中国临床解剖学杂志,2017,35(2):130-136.
[20]Se YK,Jae WJ,Bum SK,et al.Laparoscopic versus open radical nephrectomy in T2renal cell carcinoma:long-term oncologic outcomes[J].Korean J Urol,2011,52(7):474-478.