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目的:探讨后腹腔镜多囊肾切除手术技术,并与开放手术的效果进行比较评估。方法:2009年8月~2015年4月,我中心10例多囊肾患者共12例次进行腹腔镜多囊肾切除术,纳入腹腔镜组。2004年1月~2009年8月,开放切除11例多囊肾纳入开放组。对两组患者临床资料、围手术期情况等进行统计比较。结果:腹腔镜组平均年龄58.6岁(50~67岁),男8例,女2例。开放组年龄55.4岁(48~63岁),男7例,女4例。所有患者均为终末期肾病进行血液透析或腹膜透析。两组在年龄、性别、BMI、肾脏最大径以及ASA评分、术前肌酐、术前血色素、透析方式、切除侧别,输血率、术后血色素等方面差异无统计学意义。2例手术中转开放。腹腔镜组手术时间更长(215.7min vs.167.0min,P=0.019)切除标本质量小(1 279.5g vs.1 812.7g,P=0.004)。腹腔镜组在出血量(265.0ml vs.403.6ml,P=0.016)、手术切口长度(11.4cm vs.34.5cm,P<0.001)、恢复饮食的时间(1.8dvs.4.0d,P<0.001)及住院时间(12.6dvs.16.5d,P=0.005)比开放组更具优势。两组术后病理示未合并肿瘤。腹腔镜组并发症的发生率略低(25.0%vs 36.4%,P=0.667),但差异无统计学意义。结论:与开放手术向比,后腹腔镜多囊肾切除术具有出血少、切口小、恢复快的优点,并发症发生率不高,但手术时间略长。后腹腔镜多囊肾切除术是安全可行的。
Objective: To investigate the technique of retroperitoneal laparoscopic polyphoretic nephrectomy (PTC) and to evaluate the effect of open laparoscopic surgery. Methods: From Aug. 2009 to Apr. 2015, 12 cases of polycystic kidney disease in our center were treated with laparoscopic polycystic nephrectomy (12 cases) and included in the laparoscopic group. From January 2004 to August 2009, 11 cases of polycystic kidney disease were enucleated into the open group. The clinical data of two groups, perioperative period, etc. were compared statistically. Results: The average age of laparoscopic group was 58.6 years (50-67 years), 8 males and 2 females. Open group age 55.4 years (48 to 63 years), 7 males and 4 females. All patients underwent hemodialysis or peritoneal dialysis for end-stage renal disease. There was no significant difference between the two groups in age, sex, BMI, maximum diameter of kidney and ASA score, preoperative creatinine, preoperative hemoglobin, dialysis, resection side, blood transfusion rate, postoperative hemoglobin and so on. 2 cases of surgical transfer open. Laparoscopic surgery was longer (215.7 min vs 167 min, P = 0.019), and the quality of resected specimens was small (1 279.5 g vs 1 812.7 g, P = 0.004). In the laparoscopic group, there was no significant difference in the amount of bleeding (265.0ml vs.403.6ml, P = 0.016), surgical incision length (11.4cm vs.34.5cm, P <0.001), diet time (1.8d vs.4.0d, And hospital stay (12.6d vs. 16.5d, P = 0.005) had more advantages than open group. Two groups of postoperative pathology showed no tumor. The incidence of complications in the laparoscopic group was slightly lower (25.0% vs 36.4%, P = 0.667), but the difference was not statistically significant. Conclusion: Compared with the open surgery, retroperitoneal laparoscopic polycystic nephrectomy has the advantages of less bleeding, small incision, faster recovery, the incidence of complications is not high, but the operation time is slightly longer. Retroperitoneal laparoscopic polycystic nephrectomy is safe and feasible.