后腹腔镜保留肾单位手术治疗肾癌与开放手术的临床比较

发布时间：2018-09-05 20:59

【摘要】：目的探讨后腹腔镜保留肾单位手术治疗肾癌的效果与安全性；比较肾癌行后腹腔镜保留肾单位手术与开放手术的临床疗效。方法回顾性分析宁夏医科大学总医院泌尿外科自2009年1月1日至2013年12月31日采用保留肾单位手术治疗且术后病理诊断为肾癌的患者39例，其中包括开放性保留肾单位手术24例和后腹腔镜下保留肾单位手术15例。比较两组患者的手术时间、术中出血量、术中输血率、热缺血时间、术后胃肠道恢复时间、引流管拔除时间、术后住院时间、迟发型出血率、术后并发症及住院总费用。随访2—20个月，，比较两组肾癌复发情况及生存情况。结果所有手术均顺利完成，无死亡病例。RLNSS与ONSS两组在在引流管置放时间比较上无明显差异（P=0.276），而在手术时间、术中出血量、术后住院时间、肠道功能恢复时间上RLNSS组均优于ONSS组，在热缺血时间及住院费用上RLNSS则较ONSS组时间较长，二者比较有统计学意义（P=0.016），两组肾脏功能在术前、术后第1天、第3天均未见明显差异（P0.05）。结论RLNSS手术学习时间长，操作难度相对大，但RLNSS在ONSS的基础上使用了腹腔镜微创技术，一定程度的降低健侧肾脏负担，且有手术时间短、术中出血量少、术后住院时间短、肠道功能恢复较快等优点。所以说，RLNSS是一种安全、有效的微创手术方式，在把握好适应症的前提下，对于小于4cm的局限性肾癌可积极选择腹腔镜下保留肾单位手术。相信通过临床工作者不断的探索和积累，腹腔镜操作水平的进一步提高和新型辅助设备的开发，可以进一步缩短肾血管阻断时间和术中止血时间。本组研究尚需进一步远期、多样本随机对照研究。
[Abstract]:Objective to evaluate the efficacy and safety of retroperitoneal laparoscopic nephron-sparing surgery in the treatment of renal cell carcinoma and to compare the clinical efficacy between retroperitoneal laparoscopic nephron-sparing surgery and open surgery. Methods from January 1, 2009 to December 31, 2013, 39 patients with renal carcinoma were treated by nephron-sparing surgery and pathologically diagnosed as renal carcinoma, from January 1, 2009 to December 31, 2013, in the General Hospital of Ningxia Medical University. These included open nephron-sparing surgery in 24 cases and retroperitoneal laparoscopic nephron-sparing surgery in 15 cases. The operation time, intraoperative blood loss, blood transfusion rate, hot ischemia time, gastrointestinal recovery time, drainage tube extraction time, postoperative hospitalization time, delayed bleeding rate, postoperative complications and total hospitalization cost were compared between the two groups. Follow-up 2-20 months, compared the recurrence and survival of renal cell carcinoma between the two groups. Results all the operations were completed successfully. There was no significant difference between the two groups in the time of drainage tube placement (P0. 276), but the RLNSS group was better than the ONSS group in the operation time, intraoperative bleeding volume, postoperative hospitalization time, and the recovery time of intestinal function, and there was no significant difference between RLNSS group and ONSS group in the time of placement of drainage tube (P0. 276). The duration of RLNSS was longer than that of ONSS group (P0. 016). There was no significant difference in renal function between the two groups before operation, 1 day after operation and 3 days after operation (P0.05). Conclusion the operation of RLNSS is long and difficult to operate, but on the basis of ONSS, RLNSS uses laparoscopic minimally invasive technique, which can reduce the burden of healthy kidney to a certain extent, and has the advantages of short operation time, less intraoperative bleeding, and shorter hospitalization time after operation. The intestinal function recovers quickly and so on. Therefore, RLNSS is a safe and effective minimally invasive operation. Under the premise of grasping the indications, laparoscopic nephron sparing surgery can be actively selected for the localized renal carcinoma less than 4cm. It is believed that the continuous exploration and accumulation of clinical workers, the further improvement of laparoscopic operation level and the development of new auxiliary equipment can further shorten the time of renal vascular occlusion and hemostasis during operation. This study needs further long-term, multi-sample randomized controlled study.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.11

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