[1]蒲小勇,徐战平,刘久敏,等.两种入路腹腔镜下肾部分切除术治疗R.E.N.A.L.评分≥7 的肾肿瘤的比较研究[J].南方医科大学学报,2014,(12):1818.
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两种入路腹腔镜下肾部分切除术治疗R.E.N.A.L.评分≥7 的肾肿瘤的比较研究()
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《南方医科大学学报》[ISSN:/CN:]

卷:
期数:
2014年12期
页码:
1818
栏目:
出版日期:
2014-12-20

文章信息/Info

Title:
Clinical efficacy of transperitoneal verus retroperitoneal laparoscopic partial
nephrectomy for renal tumors with R. E. N. A. L score over 7
作者:
蒲小勇徐战平刘久敏郑祥光李东罗耀雄冼志勇
关键词:
肾肿瘤保留肾单位手术腹腔镜手术入路
Keywords:
kidney neoplasms nephron-paring surgery laparoscopy operative procedure
摘要:
目的对比研究经腹入路和后腹腔入路腹腔镜下肾部分切除术治疗R.E.N.A.L.评分≥7 的肾肿瘤的安全性和可行性,评价
手术疗效,对比研究其临床应用价值。方法收集2012年1月至2014年3月R.E.N.A.L.评分≥7 的肾肿瘤行经腹入路(32例,经腹
组)和后腹腔入路(30例,后腹腔组)腹腔镜下肾部分切除术患者临床资料,观察和记录手术相关参数、术后情况,评价手术疗效,
记录并发症,所有患者常规随访。比较两种手术方法的手术时间、术中估计失血量、热缺血时间、术中并发症、输血率、恢复进食
时间、住院时间、切缘阳性率等。结果经腹组1例患者转为开放手术,后腹腔组3例转为开放手术,其余患者手术均顺利完成,
两组手术在年龄、体重指数、ASA评分,Charlson并发症指数、肿瘤最大径、肾肿瘤R. E. N. A.L评分等方面差异无统计学意义
(P>0.05));两组在术中估计失血量、热缺血时间、术中并发症、输血率、切缘阳性率等方面差异无统计学意义(P>0.05);经腹组手
术时间较后腹腔组时间较短(210. 4±59.2 min vs 252±58.3 min),两者差异有统计学意义(P>0.05)。经腹组恢复进食时间(47±
10 h vs 23±6 h)和住院时间(8.4±1.9 d vs 6.5±1.6 d)较后腹腔组时间较长(P<0.05)。结论两种手术入路腹腔镜下肾部分切除术
均是治疗R.E.N.A.L.评分≥7的一种安全有效的方法。经腹入路操作空间大,容易暴露和手术操作;腹膜后入路术后恢复较快。
Abstract:
Objective To compare the safety, feasibility and efficacy of transperitoneal and retroperitoneal laparoscopic partial
nephrectomy (LPN) in the treatment of renal tumors with R. E. N. A. L score more than 7. Methods The clinical data were
collected from 62 patients undergoing transperitoneal LPN (32 cases) and retroperitoneal LPN (30 cases) for a complex renal
mass (R.E.N.A.L. score≥7) between January 2012 and March 2014. The surgical and early postoperative outcomes and
complications were analyzed to evaluate the efficacy of the treatments. The mean operative time, estimated blood loss, warm
ischemia time, surgical complications, blood transfusion rate, tolerating regular diet time, postoperative hospital stay and
surgical margin were compared between the two groups. Results The operations were completed successfully in all cases
except for 1 case in transperitoneal group and 3 in retroperitoneal group that required conversion to open surgery. No
significant differences were found in age, body mass index, ASA score, Charlson comorbidity index, tumor size or R.E.N.A.L.
nephrometry score (P>0.05), nor in estimated blood loss, warm ischemia time, intraoperative complication, blood transfusion
rate or surgical margin between the two groups (P>0.05, respectively). The transperitoneal LPN group had a shorter mean
operative time than retroperitoneal LPN group (210.4±59.2 vs 252±58.3 min, P<0.05) but showed longer tolerating regular diet
time (47±10 h vs 23±6 h, P<0.05) and postoperative hospital stay time (8.4±1.9 days vs 6.5±1.6 days, P<0.05). Conclusion Both
transperitoneal LPN and retroperitoneal LPN are safe, feasible and effective for surgical management of complex localized
tumors, but the transperitoneal procedure offers larger operative space with better exposure; the retroperitoneal procedure
better promotes postoperative recovery of the patients.

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更新日期/Last Update: 1900-01-01