后腹腔镜辅助腹腔入路治疗直径大于7cm肾肿瘤临床疗效分析
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摘要
目的研究后腹腔入路辅助腹腔入路腹腔镜治疗直径大于7cm肾肿瘤的临床价值。方法选取该院2014年1月至2017年12月治疗直径大于7cm肾肿瘤病例89例,其中经后腹腔镜辅助腹腔入路(A组)32例、腹腔镜手术(B组)30例及开放手术(C组)27例,收集3组临床资料进行比较,分析3种手术方式的手术时间、术中出血量、手术并发症、术后肠道恢复时间及术后住院天数等的差异性。结果A组2例(6.25%)出现高碳酸血症,手术时间120~200 min,平均(155.00±22.07)min;出血量80~200 mL,平均(141.56±33.76)mL;术后3~5d通气,平均(3.44±0.72)d;术后住院7~9d,平均(7.34±0.65)d;B组2例(6.67%)出现高碳酸血症,手术时间150~230min,平均(184.17±20.64)min;出血量100~260 mL,平均(191.50±46.17)mL;术后4~6d通气,平均(4.43±0.73)d;术后住院6~9d,平均(7.53±0.94)d;C组手术时间120~180min,平均(154.07±16.64)min;出血量210~400mL,平均(309.63±50.23)mL;术后4~6d通气,平均(4.74±0.59)d;术后住院7~12d,平均(8.67±1.39)d;A组手术方式在手术时间、术中出血量及术后通气时间与B、C两组相比较有优势(P<0.05),A、B两组在手术并发症及术后住院时间比较,差异无统计学意义(P>0.05),但两组较C组优势明显(P<0.05)。结论后腹腔入路辅助腹腔入路治疗直径大于7cm肾肿瘤优势明显。
Objective To study the clinical value of retroperitoneoscopic assisted intraperitoneal approach in the treatment of renal tumors with diameter >7 cm.Methods A total of 89 patients with diameter>7 cm renal tumors were selected from January 2014 to December 2017 in our hospital.Among them,32 cases were treated by retroperitoneoscopic assisted intraperitoneal approach(group A),and 30 cases were treated by laparoscopy(group B)and 27 cases accepted open surgery(group C).The clinical data were collected for comparison of three groups,statistical analysis the difference of the three surgical methods of operation time,bleeding amount,surgical complications,postoperative intestinal recovery time and postoperative hospital stay.Results Hypercapnia was found in 2 cases(6.25%)in group A.The operation time was 120-200 min with an average of(155.00±22.07)min.The bleeding amount was 80-200 mL with an average of(141.56±33.76)mL.Ventilation occurred 3-5 dafter operation with an average of(3.44±0.72)d.The patients were hospitalized for 7-9 dwith an average of(7.34±0.65)d.In group B,hypercapnia was found in 2 patients(6.67%),the time of operation was 150-230 min with an average of(184.17±20.64)min;the amount of bleeding was 100-260 mL with an average of(191.50±46.17)mL;Ventilation occurred 4-6 dafter operation with an average of(4.43±0.73)d;postoperative hospitalization 6-9 d with an average of(7.53±0.94)d;The operation time of group C was 120-180 min with an average of(154.0±16.64)min;blood loss was 210-400 mL with an average of(309.6±50.23)mL;4-6 dpostoperative ventilation with an average of(4.74±0.59)d;postoperative hospitalization 7-12 dwith an average of(8.67±1.39)d.Group A had advantages in the operation time,bleeding amount and postoperative ventilation time compared with group B,C(P<0.05).Groups A and B in the surgical complications and postoperative hospital stay showed no difference(P>0.05),but both of the two groups have obvious advantages over group C(P<0.05).Conclusion Retroperitoneoscopic assisted intraperitoneal approach is superior in the treatment of renal tumors with diameter>7 cm.
Objective To study the clinical value of retroperitoneoscopic assisted intraperitoneal approach in the treatment of renal tumors with diameter >7 cm.Methods A total of 89 patients with diameter>7 cm renal tumors were selected from January 2014 to December 2017 in our hospital.Among them,32 cases were treated by retroperitoneoscopic assisted intraperitoneal approach(group A),and 30 cases were treated by laparoscopy(group B)and 27 cases accepted open surgery(group C).The clinical data were collected for comparison of three groups,statistical analysis the difference of the three surgical methods of operation time,bleeding amount,surgical complications,postoperative intestinal recovery time and postoperative hospital stay.Results Hypercapnia was found in 2 cases(6.25%)in group A.The operation time was 120-200 min with an average of(155.00±22.07)min.The bleeding amount was 80-200 mL with an average of(141.56±33.76)mL.Ventilation occurred 3-5 dafter operation with an average of(3.44±0.72)d.The patients were hospitalized for 7-9 dwith an average of(7.34±0.65)d.In group B,hypercapnia was found in 2 patients(6.67%),the time of operation was 150-230 min with an average of(184.17±20.64)min;the amount of bleeding was 100-260 mL with an average of(191.50±46.17)mL;Ventilation occurred 4-6 dafter operation with an average of(4.43±0.73)d;postoperative hospitalization 6-9 d with an average of(7.53±0.94)d;The operation time of group C was 120-180 min with an average of(154.0±16.64)min;blood loss was 210-400 mL with an average of(309.6±50.23)mL;4-6 dpostoperative ventilation with an average of(4.74±0.59)d;postoperative hospitalization 7-12 dwith an average of(8.67±1.39)d.Group A had advantages in the operation time,bleeding amount and postoperative ventilation time compared with group B,C(P<0.05).Groups A and B in the surgical complications and postoperative hospital stay showed no difference(P>0.05),but both of the two groups have obvious advantages over group C(P<0.05).Conclusion Retroperitoneoscopic assisted intraperitoneal approach is superior in the treatment of renal tumors with diameter>7 cm.
引文
[1]ZIMMERMANN R,JANETSCHEK G.Complications of laparoscopic partial nephrectomy[J].World J Urol,2008,26(6):531-537.
[2]陈光,何金参,詹谊,等.经腹膜后入路与经腹腔入路腹腔镜手术治疗大体积肾癌的疗效[J].腹腔镜外科杂志,2016,21(2):149-151.
[3]MO X W,YANG Y,LAI H,et al.Does carbon dioxide pneumoperitoneum enhance wound metastases following laparoscopic abdominal tumor surgery?A meta-analysis of 20randomized control studies[J].Tumour Biol,2014,35(8):7351-7359.
[4]FUNAHASHI Y,MUROTANI K,YOSHINO Y,et al.The renal tumor morphological characteristics that affect surgical planning for laparoscopic or open partial nephrectomy[J].Nagoya J Med Sci,2015,77(2):229-235.
[5]HYUN O J,YUL R H,SANG K T.Factors influencing the operative approach to renal tumors:analyses according to renal nephrometry scores[J].Korean J Urol,2014,55(2):97-101.
[6]FARSHI A,JABBARI A.Retroperitoneal laparoscopic radical nephrectomy for renal masses[J].Med J Tabriz Univ Med Sci Health Serv,2015,36(6):62-67.
[7]HA U S,HWANG T K,KIM Y J,et al.Comparison of oncological outcomes of transperitoneal and retroperitoneal laparoscopic radical nephrectomy for the management of clear-cell renal cell carcinoma:a multi-institutional study[J].BJU Int,2011,107(9):1467-1472.
[8]INBAR R,SWISSA L,GREENBERG R,et al.Laparoscopic colorectal surgery in patients with impaired renal function:impact on postoperative renal function compared with open surgery[J].J Laparoendosc Adv Surg Tech A,2014,24(4):236-240.
[9]TSIVIAN M,TSIVIAN E,STANEVSKY Y,et al.Laparoscopic partial nephrectomy for tumors 7cm and above.Perioperative outcomes[J].International Braz J Urol,2017,43(5):857-862.
[10]杨波,高小峰,王辉清,等.腰腹联合三步法腹腔镜肾部分切除术的初期临床应用体会[J].第二军医大学学报,2016,37(1):83-86.
[11]SANLI O,TEFIK T,ERDEM S,et al.Use of a combined retroperitoneoscopic and transperitoneal laparoscopic technique for the management of renal cell carcinoma with level I tumor thrombi[J].J Minim Access Surg,2013,9(4):168-172.
[12]唐琦,李学松,周利群.联合腹膜后及经腹入路腹腔镜治疗肾癌伴下腔静脉瘤栓[J/CD].泌尿外科杂志(电子版),2015,8(3):1-3.
[13]O′SULLIVAN M,KEARNEY D E,GIRI S K,et al.Combined laparoscopic-assisted nephrectomy and complete mesocolic excision for synchronous renal and colon cancers[J].BMJ Case Rep,2015,2015:bcr2015211681.
[14]KAWANISHI H,ITO K,KAMIDO S,et al.Advantage of urological experience with both transperitoneal and retroperitoneal laparoscopy in lymph node biopsy for malignant lymphoma diagnosis[J].Investig Clin Urol,2016,57(6):401-407.
[2]陈光,何金参,詹谊,等.经腹膜后入路与经腹腔入路腹腔镜手术治疗大体积肾癌的疗效[J].腹腔镜外科杂志,2016,21(2):149-151.
[3]MO X W,YANG Y,LAI H,et al.Does carbon dioxide pneumoperitoneum enhance wound metastases following laparoscopic abdominal tumor surgery?A meta-analysis of 20randomized control studies[J].Tumour Biol,2014,35(8):7351-7359.
[4]FUNAHASHI Y,MUROTANI K,YOSHINO Y,et al.The renal tumor morphological characteristics that affect surgical planning for laparoscopic or open partial nephrectomy[J].Nagoya J Med Sci,2015,77(2):229-235.
[5]HYUN O J,YUL R H,SANG K T.Factors influencing the operative approach to renal tumors:analyses according to renal nephrometry scores[J].Korean J Urol,2014,55(2):97-101.
[6]FARSHI A,JABBARI A.Retroperitoneal laparoscopic radical nephrectomy for renal masses[J].Med J Tabriz Univ Med Sci Health Serv,2015,36(6):62-67.
[7]HA U S,HWANG T K,KIM Y J,et al.Comparison of oncological outcomes of transperitoneal and retroperitoneal laparoscopic radical nephrectomy for the management of clear-cell renal cell carcinoma:a multi-institutional study[J].BJU Int,2011,107(9):1467-1472.
[8]INBAR R,SWISSA L,GREENBERG R,et al.Laparoscopic colorectal surgery in patients with impaired renal function:impact on postoperative renal function compared with open surgery[J].J Laparoendosc Adv Surg Tech A,2014,24(4):236-240.
[9]TSIVIAN M,TSIVIAN E,STANEVSKY Y,et al.Laparoscopic partial nephrectomy for tumors 7cm and above.Perioperative outcomes[J].International Braz J Urol,2017,43(5):857-862.
[10]杨波,高小峰,王辉清,等.腰腹联合三步法腹腔镜肾部分切除术的初期临床应用体会[J].第二军医大学学报,2016,37(1):83-86.
[11]SANLI O,TEFIK T,ERDEM S,et al.Use of a combined retroperitoneoscopic and transperitoneal laparoscopic technique for the management of renal cell carcinoma with level I tumor thrombi[J].J Minim Access Surg,2013,9(4):168-172.
[12]唐琦,李学松,周利群.联合腹膜后及经腹入路腹腔镜治疗肾癌伴下腔静脉瘤栓[J/CD].泌尿外科杂志(电子版),2015,8(3):1-3.
[13]O′SULLIVAN M,KEARNEY D E,GIRI S K,et al.Combined laparoscopic-assisted nephrectomy and complete mesocolic excision for synchronous renal and colon cancers[J].BMJ Case Rep,2015,2015:bcr2015211681.
[14]KAWANISHI H,ITO K,KAMIDO S,et al.Advantage of urological experience with both transperitoneal and retroperitoneal laparoscopy in lymph node biopsy for malignant lymphoma diagnosis[J].Investig Clin Urol,2016,57(6):401-407.