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目的探讨肾细胞癌后腹腔镜下根治性切除术的临床应用价值。方法回顾性分析后腹腔镜下根治性肾切除术(A组32例)及开放性根治性肾切除术(B组51例)的临床资料。比较两组手术时间、术中出血量、术后肠功能恢复时间、局部复发、切口种植转移等指标。结果A组手术时间中位数75(50～150)min,术中出血量中位数60(20～450)mL。术后肠功能恢复时间中位数1.5(1～2)d,术后切口感染4例(12.5%),切口侧下腹部皮肤感觉过敏者7例(21.9%);B组手术时间中位数100(75～180)min,术中出血量中位数150(100～500)mL。术后肠功能恢复时间中位数2(1～3)d,术后切口感染6例(11.8%)。切口侧下腹部皮肤感觉过敏者17例(33.3%)。两组均无严重并发症出现。A组在手术时间、术中出血量、术后肠功能恢复时间方面明显优于B组(P<0.01)。结论后腹腔镜下根治性肾切除术较开放手术治疗肾癌具有微创、安全、可靠等特点。无局部重要脏器及大血管浸润和黏连的肾癌病例均适合行后腹腔镜手术切除。
Objective To investigate the clinical value of laparoscopic radical resection of renal cell carcinoma. Methods The clinical data of laparoscopic radical nephrectomy (group A, 32 cases) and open radical nephrectomy (group B, 51 cases) were retrospectively analyzed. The operation time, intraoperative blood loss, postoperative intestinal function recovery time, local recurrence and incision implant metastasis were compared between the two groups. Results The median operative time in group A was 75 (50-150) min and the median amount of intraoperative bleeding was 60 (20-450) mL. The median time to recovery of bowel function was 1.5 (1-2 days) postoperatively, 4 cases (12.5%) were incisional wound infection and 7 cases (21.9%) were skin sensitization in the incision side lower abdomen. The median operative time 100 (75 ~ 180) min, the median blood loss was 150 (100 ~ 500) mL. The median time to recovery of bowel function was 2 (1-3 days) and 6 (11.8%) were incisional wound infection. 17 cases (33.3%) had sensation of cutaneous side lower abdominal skin sensation. No serious complications occurred in both groups. Group A was significantly better than group B in operation time, intraoperative blood loss and postoperative recovery of intestinal function (P <0.01). Conclusions Retroperitoneal laparoscopic radical nephrectomy is more invasive, safe and reliable than open surgery in the treatment of renal cell carcinoma. No local important organs and vascular invasion and adhesion of renal cell carcinoma cases are suitable for laparoscopic resection.