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目的比较腹腔镜和开放保留肾单位手术治疗T1a期肾癌的手术特点和临床疗效。方法回顾性分析115例同一术者行保留肾单位手术治疗T1a期肾癌患者临床资料,其中腹腔镜手术55例,开放手术60例。比较两种手术方法的手术时间、肾脏缺血时间、失血量、住院时间、并发症及肾功能恢复的差别。结果腹腔镜组手术时间为165～255min,平均(212.0±45.3)min;开放组为95～138min,平均(140.7±25.6)min,差异有统计学意义(P=0.000)。腹腔镜组肾缺血时间为25～45min,平均(41.3±5.4)min;开放组为15～26min,平均(24.4±5.7)min,差异有统计学意义(P=0.000)。腹腔镜组失血量为100～250ml,平均(168.8±51.7)ml;开放组为200～550ml,平均(285.3±77.9)ml,差异有统计学意义(P=0.000)。腹腔镜组术后住院天数为6～10d,平均(6.2±0.5)d;开放组为7～15d,平均(7.1±0.6)d,差异有统计学意义(P=0.001)。腹腔镜组、开放组手术并发症发生率分别为7.3%(4/55)、18.3%(11/60),差异有统计学意义(P=0.044)。术后中位随访时间18(6～32)个月,除失访和其他原因死亡外,无一例出现肿瘤复发和远处转移,两组间双肾总肾小球滤过率(GFR)变化差异无统计学意义(P=0.105)。结论腹腔镜保留肾单位手术较开放手术具有失血量少、术后住院时间短、手术并发症少等优势,且手术时间和肾缺血时间的延长并未明显影响术后肾功能恢复和远期预后。
Objective To compare the surgical characteristics and clinical efficacy of laparoscopic and open nephron-surgeries in the treatment of stage T1a renal cell carcinoma. Methods A retrospective analysis of 115 cases of the same operation in patients with retained nephron spondylosis T1a renal cell carcinoma clinical data, including 55 cases of laparoscopic surgery, 60 cases of open surgery. The difference of operation time, renal ischemia time, blood loss, length of hospital stay, complications and renal function recovery were compared between the two methods. Results The operation time of laparoscopic group was 165 ~ 255min (mean, 212.0 ± 45.3) min. The open group was 95 ~ 138min, with an average of (140.7 ± 25.6) min, the difference was statistically significant (P = 0.000). The duration of renal ischemia in laparoscopic group was 25-45 minutes (mean, 41.3 ± 5.4) min; in open group, it was 15-26 minutes, with an average of (24.4 ± 5.7) min, the difference was statistically significant (P = 0.000). The blood loss of laparoscopic group was 100 ~ 250ml, with an average of (168.8 ± 51.7) ml; the open group was 200 ~ 550ml, with an average of (285.3 ± 77.9) ml, the difference was statistically significant (P = 0.000). The length of hospital stay in laparoscopic group was 6-10 days, with an average of (6.2 ± 0.5) days; in open group it was 7-15 days (7.1 ± 0.6 days), with statistically significant difference (P = 0.001). The incidence of complications in laparoscopic group and open group were 7.3% (4/55) and 18.3% (11/60), respectively, with significant difference (P = 0.044). The median follow-up time was 18 (6 ~ 32) months. No tumor recurrence or distant metastasis was found except for the loss of follow-up and other causes. The change of total glomerular filtration rate (GFR) The difference was not statistically significant (P = 0.105). Conclusions Laparoscopic nephron-preserving surgery has the advantages of less blood loss, shorter postoperative hospital stay and fewer complications compared with open surgery. The prolonged operation time and renal ischemia have no significant effect on postoperative renal function recovery and long-term Prognosis.