后腹腔鏡保留腎單位手術(shù)治療腎癌與開放手術(shù)的臨床比較
發(fā)布時間：2018-09-05 20:59
【摘要】：目的探討后腹腔鏡保留腎單位手術(shù)治療腎癌的效果與安全性；比較腎癌行后腹腔鏡保留腎單位手術(shù)與開放手術(shù)的臨床療效。 方法回顧性分析寧夏醫(yī)科大學總醫(yī)院泌尿外科自2009年1月1日至2013年12月31日采用保留腎單位手術(shù)治療且術(shù)后病理診斷為腎癌的患者39例，其中包括開放性保留腎單位手術(shù)24例和后腹腔鏡下保留腎單位手術(shù)15例。比較兩組患者的手術(shù)時間、術(shù)中出血量、術(shù)中輸血率、熱缺血時間、術(shù)后胃腸道恢復時間、引流管拔除時間、術(shù)后住院時間、遲發(fā)型出血率、術(shù)后并發(fā)癥及住院總費用。隨訪2—20個月，，比較兩組腎癌復發(fā)情況及生存情況。 結(jié)果所有手術(shù)均順利完成，無死亡病例。RLNSS與ONSS兩組在在引流管置放時間比較上無明顯差異（P=0.276），而在手術(shù)時間、術(shù)中出血量、術(shù)后住院時間、腸道功能恢復時間上RLNSS組均優(yōu)于ONSS組，在熱缺血時間及住院費用上RLNSS則較ONSS組時間較長，二者比較有統(tǒng)計學意義（P=0.016），兩組腎臟功能在術(shù)前、術(shù)后第1天、第3天均未見明顯差異（P0.05）。 結(jié)論RLNSS手術(shù)學習時間長，操作難度相對大，但RLNSS在ONSS的基礎(chǔ)上使用了腹腔鏡微創(chuàng)技術(shù)，一定程度的降低健側(cè)腎臟負擔，且有手術(shù)時間短、術(shù)中出血量少、術(shù)后住院時間短、腸道功能恢復較快等優(yōu)點。所以說，RLNSS是一種安全、有效的微創(chuàng)手術(shù)方式，在把握好適應癥的前提下，對于小于4cm的局限性腎癌可積極選擇腹腔鏡下保留腎單位手術(shù)。相信通過臨床工作者不斷的探索和積累，腹腔鏡操作水平的進一步提高和新型輔助設(shè)備的開發(fā)，可以進一步縮短腎血管阻斷時間和術(shù)中止血時間。本組研究尚需進一步遠期、多樣本隨機對照研究。
[Abstract]:Objective to evaluate the efficacy and safety of retroperitoneal laparoscopic nephron-sparing surgery in the treatment of renal cell carcinoma and to compare the clinical efficacy between retroperitoneal laparoscopic nephron-sparing surgery and open surgery. Methods from January 1, 2009 to December 31, 2013, 39 patients with renal carcinoma were treated by nephron-sparing surgery and pathologically diagnosed as renal carcinoma, from January 1, 2009 to December 31, 2013, in the General Hospital of Ningxia Medical University. These included open nephron-sparing surgery in 24 cases and retroperitoneal laparoscopic nephron-sparing surgery in 15 cases. The operation time, intraoperative blood loss, blood transfusion rate, hot ischemia time, gastrointestinal recovery time, drainage tube extraction time, postoperative hospitalization time, delayed bleeding rate, postoperative complications and total hospitalization cost were compared between the two groups. Follow-up 2-20 months, compared the recurrence and survival of renal cell carcinoma between the two groups. Results all the operations were completed successfully. There was no significant difference between the two groups in the time of drainage tube placement (P0. 276), but the RLNSS group was better than the ONSS group in the operation time, intraoperative bleeding volume, postoperative hospitalization time, and the recovery time of intestinal function, and there was no significant difference between RLNSS group and ONSS group in the time of placement of drainage tube (P0. 276). The duration of RLNSS was longer than that of ONSS group (P0. 016). There was no significant difference in renal function between the two groups before operation, 1 day after operation and 3 days after operation (P0.05). Conclusion the operation of RLNSS is long and difficult to operate, but on the basis of ONSS, RLNSS uses laparoscopic minimally invasive technique, which can reduce the burden of healthy kidney to a certain extent, and has the advantages of short operation time, less intraoperative bleeding, and shorter hospitalization time after operation. The intestinal function recovers quickly and so on. Therefore, RLNSS is a safe and effective minimally invasive operation. Under the premise of grasping the indications, laparoscopic nephron sparing surgery can be actively selected for the localized renal carcinoma less than 4cm. It is believed that the continuous exploration and accumulation of clinical workers, the further improvement of laparoscopic operation level and the development of new auxiliary equipment can further shorten the time of renal vascular occlusion and hemostasis during operation. This study needs further long-term, multi-sample randomized controlled study.
【學位授予單位】：寧夏醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.11
本文編號：2225445
[Abstract]:Objective to evaluate the efficacy and safety of retroperitoneal laparoscopic nephron-sparing surgery in the treatment of renal cell carcinoma and to compare the clinical efficacy between retroperitoneal laparoscopic nephron-sparing surgery and open surgery. Methods from January 1, 2009 to December 31, 2013, 39 patients with renal carcinoma were treated by nephron-sparing surgery and pathologically diagnosed as renal carcinoma, from January 1, 2009 to December 31, 2013, in the General Hospital of Ningxia Medical University. These included open nephron-sparing surgery in 24 cases and retroperitoneal laparoscopic nephron-sparing surgery in 15 cases. The operation time, intraoperative blood loss, blood transfusion rate, hot ischemia time, gastrointestinal recovery time, drainage tube extraction time, postoperative hospitalization time, delayed bleeding rate, postoperative complications and total hospitalization cost were compared between the two groups. Follow-up 2-20 months, compared the recurrence and survival of renal cell carcinoma between the two groups. Results all the operations were completed successfully. There was no significant difference between the two groups in the time of drainage tube placement (P0. 276), but the RLNSS group was better than the ONSS group in the operation time, intraoperative bleeding volume, postoperative hospitalization time, and the recovery time of intestinal function, and there was no significant difference between RLNSS group and ONSS group in the time of placement of drainage tube (P0. 276). The duration of RLNSS was longer than that of ONSS group (P0. 016). There was no significant difference in renal function between the two groups before operation, 1 day after operation and 3 days after operation (P0.05). Conclusion the operation of RLNSS is long and difficult to operate, but on the basis of ONSS, RLNSS uses laparoscopic minimally invasive technique, which can reduce the burden of healthy kidney to a certain extent, and has the advantages of short operation time, less intraoperative bleeding, and shorter hospitalization time after operation. The intestinal function recovers quickly and so on. Therefore, RLNSS is a safe and effective minimally invasive operation. Under the premise of grasping the indications, laparoscopic nephron sparing surgery can be actively selected for the localized renal carcinoma less than 4cm. It is believed that the continuous exploration and accumulation of clinical workers, the further improvement of laparoscopic operation level and the development of new auxiliary equipment can further shorten the time of renal vascular occlusion and hemostasis during operation. This study needs further long-term, multi-sample randomized controlled study.
【學位授予單位】：寧夏醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.11
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