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目的:比较3D腹腔镜与2D腹腔镜下行肾部分切除的疗效。方法:于2013年10月~2014年7月应用腹腔镜技术行肾部分切除术30例,15例为3D腹腔镜肾部分切除术(3D组),15例为2D腹腔镜肾部分切除术(2D组)。3D组和2D组均应用后腹腔途径,3D组中1例为无肾动脉阻断肾部分切除术。将3D组和2D组的临床资料进行分析。结果:30例手术均成功完成,均未中转开放。3D组手术时间(74±24)min明显短于2D组(105±49)min,两组比较差异有统计学意义(P=0.036)。然而在热缺血时间、术中出血量、术前、术后血肌酐变化、引流管留置时间、术后住院时间等方面,3D组未显示出明显优势。术后病理提示囊性肾癌1例,错构瘤3例,肾囊肿1例,肾透明细胞癌25例。30例术后随访4~12个月,平均6个月,未见肿瘤复发或转移病例。结论:3D腹腔镜技术较传统2D腹腔镜技术在空间定位及深度感觉上有明显优势,一定程度上降低了手术难度,缩短了手术时间,是一项值得推广的技术。
Objective: To compare the efficacy of 3D laparoscopic and 2D laparoscopic partial nephrectomy. Methods: From October 2013 to July 2014, 30 cases underwent partial nephrectomy with laparoscopy, 15 cases with 3D laparoscopic partial nephrectomy (3D) and 15 cases with 2D laparoscopic partial nephrectomy 2D group). The posterior abdominal approach was applied to both the 3D and 2D groups, and in the 3D group, no renal artery was used to block the partial nephrectomy. The clinical data of 3D group and 2D group were analyzed. Results: All the 30 surgeries were successfully completed and none of them were transferred to open. The operation time of 3D group (74 ± 24) min was significantly shorter than that of 2D group (105 ± 49) min, the difference was statistically significant (P = 0.036). However, the 3D group did not show obvious advantages in the time of warm ischemia, intraoperative blood loss, preoperative and postoperative changes of serum creatinine, drainage tube indwelling time and postoperative hospital stay. Postoperative pathology showed cystic renal cell carcinoma in 1 case, hamartoma in 3 cases, renal cyst in 1 case and renal clear cell carcinoma in 25 cases. 30 cases were followed up for 4 to 12 months, an average of 6 months, no tumor recurrence or metastasis. Conclusion: Compared with conventional 2D laparoscopy, 3D laparoscopy has obvious advantages in spatial location and depth perception, which reduces the operation difficulty and shortens the operation time to a certain degree, which is worth popularizing.