经腹腔与后腹膜入路行腹腔镜根治性肾切除术的临床疗效比较
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摘要
目的探讨经腹腔和经后腹膜途径行腹腔镜根治性肾切除术的临床效果和安全性。方法回顾性分析2007年3月至2017年9月于本院接受腹腔镜根治性肾切除术的56例患者的临床资料,按照手术入路方式不同将其分为经腹腔组(30例)和经后腹膜组(26例),比较两组患者术中相关指标(包括手术时间、术中出血量、有无输血、中转开腹及术中并发症)及术后相关指标(包括入ICU例数、开始进食时间、住院天数、全身炎症反应综合征及并发症发生情况)。结果经后腹膜组患者手术时间和术后开始进食时间均显著短于经腹腔组(P_均<0.05),其他指标比较差异均无显著性(P_均> 0.05)。结论经腹腔和经后腹膜入路行腹腔镜根治性肾切除术均安全可行,经验丰富的术者应于术前充分评估患者具体情况和手术难度,合理把握适应证,选择最有利于患者的手术方式。
Objective To compare the clinical effect and safety of laparoscopic radical nephrectomy through transperitoneal and retroperitoneal approaches. Method The clinical data of 56 patients undergoing laparoscopic radical nephrectomy in our hospital from March 2007 to September 2017 were analyzed retrospectively, they were divided into transperitoneal group(n = 30) and retroperitoneal group(n = 26) according to the way of operation. The intraoperative related indexes(including operation time,intraoperative blood loss, blood transfusion, conversion to laparotomy and complications) and postoperative related indexes [including the number of cases entering ICU, time to start eating after operation, the number of days in hospital, the occurrence of systemtic in?ammation response syndrome(SIRS) and complications] were compared between the two groups. Result The time of operation and time to start eating after operation in retroperitoneal group were signi?cantly shorter than those in transperitoneal group(P_(all)<0.05),but there were no signi?cant differences in other indexes(P_(all)> 0.05). Conclusion Therapeutic laparoscopy through transperitoneal and retroperitoneal approach is all safe and feasible, operators should fully evaluate the speci?c situation of patients and the dif?culty of operation before operation, reasonably grasp the indications, and choose the most favorable surgical method for patients.
Objective To compare the clinical effect and safety of laparoscopic radical nephrectomy through transperitoneal and retroperitoneal approaches. Method The clinical data of 56 patients undergoing laparoscopic radical nephrectomy in our hospital from March 2007 to September 2017 were analyzed retrospectively, they were divided into transperitoneal group(n = 30) and retroperitoneal group(n = 26) according to the way of operation. The intraoperative related indexes(including operation time,intraoperative blood loss, blood transfusion, conversion to laparotomy and complications) and postoperative related indexes [including the number of cases entering ICU, time to start eating after operation, the number of days in hospital, the occurrence of systemtic in?ammation response syndrome(SIRS) and complications] were compared between the two groups. Result The time of operation and time to start eating after operation in retroperitoneal group were signi?cantly shorter than those in transperitoneal group(P_(all)<0.05),but there were no signi?cant differences in other indexes(P_(all)> 0.05). Conclusion Therapeutic laparoscopy through transperitoneal and retroperitoneal approach is all safe and feasible, operators should fully evaluate the speci?c situation of patients and the dif?culty of operation before operation, reasonably grasp the indications, and choose the most favorable surgical method for patients.
引文
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[15]蔡海荣,刘晟,张海涛,等.经后腹腔镜和开放性肾癌根治术治疗T2期肾细胞癌的比较[J].中华全科医学,2014,12(4):576-577.
[16]陈放,熊玮,杜杨春,等.后腹腔镜肾癌根治术治疗T2期肾细胞癌的疗效分析[J].重庆医学,2015,44(12):1692-1694.
[17]陈小楠,王科峰,徐振群,等.经腹腹腔镜处理大体积肾癌81例的临床疗效与经验[J].医学临床研究,2014,31(1):36-38.
[18]秦光明,方利强.经腹膜后入路与经腹腔入路腹腔镜手术治疗大体积肾癌的疗效对比观察[J].腹腔镜外科杂志,2015,20(6):468-471.
[19]门群利,郭刚,蔡伟,等.后腹腔镜术中腹膜反折的辨识与腹膜损伤处理方法[J].微创泌尿外科杂志,2014,3(2):96-99.
[20]Yang L,Fan T,Wei Q,et al.Transient Variations in the Serum Concentrations of Cell Adhesion Molecules Following Retroperitoneal Laparoscopic and Open Radical Nephrectomy for Localized Renal-Cell Carcinoma[J].J Endourol,2012,26(10):1323-1328.
[21]Taue R,Izaki H,Koizumi T,et al.Transperitoneal versus retroper itoneal laparoscopic radical nephrectomy:a comparative study[J].Int J Urol,2009,16(3):263-267.
[2]张卫玮,曹润福.经腹腹腔镜与后腹膜腹腔镜根治性肾切除治疗肾癌的Meta分析[J].中国组织工程研究,2010,14(53):10002-10006.
[3]Gaur DD.Laparoscopic operative retroperitoneoscopy:use of a new device[J].J Urol,1992,148(4):1137-1139.
[4]李志江,程新登,李国栋.经腹腹腔镜与后腹膜腹腔镜肾癌根治性肾切除术的比较[J].全科医学临床与教育,2014,12(3):322-323.
[5]董爱明,赖飞,曾建.后腹腔镜下与开放性肾癌根治术治疗局限性肾癌疗效比较[J].海南医学,2017,28(9):3219-3221.
[6]时振国,徐珀,李志军,等.经腹膜后腹腔镜程序化游离肾脏肾癌根治术的疗效[J].实用医学杂志,2017,33(19):3260-3262.
[7]徐遵礼,王林辉,陈伟,等.经腹与经后腹膜途径行腹腔镜根治性肾切除术的临床疗效比较[J].第二军医大学学报,2011,32(9):938-941.
[8]吴朝阳.不同入路腹腔镜手术与开放手术治疗大体积肾癌临床疗效的对比研究[J].解放军医学杂志,2016,41(1):58-61.
[9]Cuccurullo V,Mansi L.AJCC Cancer Staging Handbook:from the AJCC Cancer Staging Manual(7th edition)[J].Eur J Nucl Med Mol Imaging,2011,38(2):408.
[10]Luo JH,Zhou FJ,Xie D,et al.Analysis of long-term survival in patients with localized renal cell carcinoma:laparoscopic versus open radical nephrectomy[J].World J Urol,2010,28(3):289-293.
[11]王先龙,姜福全,张刚,等.老年患者腹腔镜与开放肾部分切除术治疗局限性肾癌安全性及疗效对比[J].中国老年学杂志,2016,36(5):1122-1124.
[12]Aguilera Bazán A,Pérez Utrilla M,Girón M,et al.Laparoscopic radical nephrectomy.Procedure,results,and complications[J].Actas Urol Esp,2009,33(5):544-549.
[13]Wu SD,Lesani OA,Zhao LC,et al.A multi-institutional study on the safety and efficacy of specimen morcellation after laparo scopic radical nephrectomy for clinical stage T1 or T2 renal cell carcinoma[J].J Endourol,2009,23(9):1513-1518.
[14]农绍军,黄群,梁庆祖.经腹腔与腹膜后行腹腔镜肾癌根治术的比较[J].腹腔镜外科杂志,2006,11(4):301-302.
[15]蔡海荣,刘晟,张海涛,等.经后腹腔镜和开放性肾癌根治术治疗T2期肾细胞癌的比较[J].中华全科医学,2014,12(4):576-577.
[16]陈放,熊玮,杜杨春,等.后腹腔镜肾癌根治术治疗T2期肾细胞癌的疗效分析[J].重庆医学,2015,44(12):1692-1694.
[17]陈小楠,王科峰,徐振群,等.经腹腹腔镜处理大体积肾癌81例的临床疗效与经验[J].医学临床研究,2014,31(1):36-38.
[18]秦光明,方利强.经腹膜后入路与经腹腔入路腹腔镜手术治疗大体积肾癌的疗效对比观察[J].腹腔镜外科杂志,2015,20(6):468-471.
[19]门群利,郭刚,蔡伟,等.后腹腔镜术中腹膜反折的辨识与腹膜损伤处理方法[J].微创泌尿外科杂志,2014,3(2):96-99.
[20]Yang L,Fan T,Wei Q,et al.Transient Variations in the Serum Concentrations of Cell Adhesion Molecules Following Retroperitoneal Laparoscopic and Open Radical Nephrectomy for Localized Renal-Cell Carcinoma[J].J Endourol,2012,26(10):1323-1328.
[21]Taue R,Izaki H,Koizumi T,et al.Transperitoneal versus retroper itoneal laparoscopic radical nephrectomy:a comparative study[J].Int J Urol,2009,16(3):263-267.