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目的通过对比单孔腹腔镜和标准腹腔镜下肾部分切除术的临床疗效,探讨单孔腹腔镜肾部分切除术的手术特点及其安全性、可行性和优缺点。方法 2009年8月至2015年2月同一手术组完成的12例单孔腹腔镜肾部分切除术,选择手术日期相近、肿瘤大小和DAP评分类似、进行标准腹腔镜肾部分切除术的患者22例作为对照组,回顾性分析两组患者的临床资料,比较临床疗效。结果两组共34例患者均顺利完成手术,无中转开放手术。两组患者的体质量指数、肿瘤大小、DAP评分差异均无统计学意义(P>0.05)。单孔组和标准腹腔镜组术后肠道恢复时间分别为(1.50±0.71)d和(2.45±0.96)d,疼痛评分分别为3.5±1.2和4.3±0.9,切口满意度评分分别为8.1±1.8和7.2±2.1,差异均有统计学意义(P<0.05);手术时间分别为(213.1±33.9)min和(208.5±65.7)min,术中出血量分别为(92.7±66.8)mL和(162.3±168.1)mL、热缺血时间分别为(20.5±12.8)min和(19.5±7.5)min,差异均无统计学意义(P>0.05)。术前和术后1个月分别采用99mTc-DTPA测定双肾肾小球滤过率(GFR),单孔组和标准腹腔镜组患肾术后GFR较术前分别下降(3.7±8.6)mL/min和(8.9±10.1)mL/min,差异无统计学意义(P>0.05)。结论单孔多通道腹腔镜肾切除术安全、有效,对于肿瘤直径较小、位置较好的肾肿瘤的治疗效果与标准腹腔镜相似。
Objective To compare the clinical efficacy of single-hole laparoscopic and standard laparoscopic partial nephrectomy in order to discuss the surgical characteristics, safety, feasibility, advantages and disadvantages of single-hole laparoscopic partial nephrectomy. Methods From August 2009 to February 2015, 12 cases of single-hole laparoscopic partial nephrectomy performed in the same operation group were selected. Twenty-two patients underwent standard laparoscopic partial nephrectomy with similar operative date, similar tumor size and DAP score As a control group, the clinical data of two groups of patients were retrospectively analyzed, and the clinical efficacy was compared. Results A total of 34 patients in both groups completed the operation smoothly without open surgery. Body mass index, tumor size and DAP score were not significantly different between the two groups (P> 0.05). The intestinal recovery time was (1.50 ± 0.71) days and (2.45 ± 0.96) days in the single-hole group and the standard laparoscopic group respectively, the scores of pain score were 3.5 ± 1.2 and 4.3 ± 0.9 respectively, and the satisfaction scores of incision were 8.1 ± 1.8 and 7.2 ± 2.1, respectively, the differences were statistically significant (P <0.05). The operative time was (213.1 ± 33.9) min and (208.5 ± 65.7) min respectively, and the blood loss were (92.7 ± 66.8) mL and 162.3 ± 168.1) mL, and the warm ischemic time was (20.5 ± 12.8) min and (19.5 ± 7.5) min, respectively, with no significant difference (P> 0.05). The renal glomerular filtration rate (GFR) was measured by 99mTc-DTPA before operation and one month after operation respectively. The GFR in the one-hole group and the standard laparoscopic group decreased 3.7 ± 8.6 mL / min and (8.9 ± 10.1) mL / min, respectively, with no significant difference (P> 0.05). Conclusions The single-hole multi-channel laparoscopic nephrectomy is safe and effective. The treatment effect of small diameter renal tumor with good tumor location is similar to that of standard laparoscopy.