中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2013年
11期
805-809
,共5页
孟一森%范宇%李德润%陈代晖%王宇%张骞%周利群%金杰
孟一森%範宇%李德潤%陳代暉%王宇%張鶱%週利群%金傑
맹일삼%범우%리덕윤%진대휘%왕우%장건%주리군%금걸
腹腔镜%肾部分切除术%肾肿瘤%腹膜后
腹腔鏡%腎部分切除術%腎腫瘤%腹膜後
복강경%신부분절제술%신종류%복막후
Laparoscopes%Partial nephrectomy%Kidney neoplasms%Retroperitoneal
目的 评价后腹腔镜下肾部分切除术治疗直径＞4 cm肾肿瘤的安全性和有效性.方法 回顾性分析2005年6月至2012年6月358例因肾细胞癌行后腹腔镜下肾部分切除术的患者资料.肾肿瘤直径0.7～7.9 cm,平均2.8 cm.根据肿瘤直径≤4.0 cm和＞4.0 cm将患者分为两组,两组分别为307、51例.比较两组间术前临床指标(性别、年龄、肿瘤特征)、围手术期因素(手术时间、热缺血时间、出血量、住院时间)和术后早期并发症的差异. 结果 358例手术切缘均为阴性.肿瘤直径≤4.0 cm组和＞4.0 cm组的肿瘤分级(P=0.017)、集合系统修复(34.9％和72.5％,P=0.000)、住院时间[(10.7±8.1)和(13.1±5.3)d,P=0.008]、术中并发症发生率(3.9％和13.7％,P=0.002)及术后早期并发症发生率(2.0％和13.7％,P=0.000)比较差异均有统计学意义,而热缺血时间[(23.9±11.1)和(25.7±11.7) min,P=0.288]差异无统计学意义. 结论 与≤4.0 cm的肾肿瘤相比,肿瘤直径＞4.0 cm的后腹腔镜下肾部分切除术的并发症发生率增高、住院时间延长.但两组间热缺血时间和手术切缘差异无统计学意义.因此,对于单发的、肿瘤直径＞4.0 cm的肾癌患者,术前影像学评估可行保留肾单位的肾部分切除术时,后腹腔镜下手术是一种可以选择的手术方式.
目的 評價後腹腔鏡下腎部分切除術治療直徑＞4 cm腎腫瘤的安全性和有效性.方法 迴顧性分析2005年6月至2012年6月358例因腎細胞癌行後腹腔鏡下腎部分切除術的患者資料.腎腫瘤直徑0.7～7.9 cm,平均2.8 cm.根據腫瘤直徑≤4.0 cm和＞4.0 cm將患者分為兩組,兩組分彆為307、51例.比較兩組間術前臨床指標(性彆、年齡、腫瘤特徵)、圍手術期因素(手術時間、熱缺血時間、齣血量、住院時間)和術後早期併髮癥的差異. 結果 358例手術切緣均為陰性.腫瘤直徑≤4.0 cm組和＞4.0 cm組的腫瘤分級(P=0.017)、集閤繫統脩複(34.9％和72.5％,P=0.000)、住院時間[(10.7±8.1)和(13.1±5.3)d,P=0.008]、術中併髮癥髮生率(3.9％和13.7％,P=0.002)及術後早期併髮癥髮生率(2.0％和13.7％,P=0.000)比較差異均有統計學意義,而熱缺血時間[(23.9±11.1)和(25.7±11.7) min,P=0.288]差異無統計學意義. 結論 與≤4.0 cm的腎腫瘤相比,腫瘤直徑＞4.0 cm的後腹腔鏡下腎部分切除術的併髮癥髮生率增高、住院時間延長.但兩組間熱缺血時間和手術切緣差異無統計學意義.因此,對于單髮的、腫瘤直徑＞4.0 cm的腎癌患者,術前影像學評估可行保留腎單位的腎部分切除術時,後腹腔鏡下手術是一種可以選擇的手術方式.
목적 평개후복강경하신부분절제술치료직경＞4 cm신종류적안전성화유효성.방법 회고성분석2005년6월지2012년6월358례인신세포암행후복강경하신부분절제술적환자자료.신종류직경0.7～7.9 cm,평균2.8 cm.근거종류직경≤4.0 cm화＞4.0 cm장환자분위량조,량조분별위307、51례.비교량조간술전림상지표(성별、년령、종류특정)、위수술기인소(수술시간、열결혈시간、출혈량、주원시간)화술후조기병발증적차이. 결과 358례수술절연균위음성.종류직경≤4.0 cm조화＞4.0 cm조적종류분급(P=0.017)、집합계통수복(34.9％화72.5％,P=0.000)、주원시간[(10.7±8.1)화(13.1±5.3)d,P=0.008]、술중병발증발생솔(3.9％화13.7％,P=0.002)급술후조기병발증발생솔(2.0％화13.7％,P=0.000)비교차이균유통계학의의,이열결혈시간[(23.9±11.1)화(25.7±11.7) min,P=0.288]차이무통계학의의. 결론 여≤4.0 cm적신종류상비,종류직경＞4.0 cm적후복강경하신부분절제술적병발증발생솔증고、주원시간연장.단량조간열결혈시간화수술절연차이무통계학의의.인차,대우단발적、종류직경＞4.0 cm적신암환자,술전영상학평고가행보류신단위적신부분절제술시,후복강경하수술시일충가이선택적수술방식.
Objective To compare the perioperative outcomes and early postoperative complications of retroperitoneal laparoscopic partial nephrectomy to treat renal cell carcinoma in patients with tumor ＞4.0 cm and those with tumor ≤4.0 cm.Methods Three hundred and fifty-eight patients who had undergone retroperitoneal laparoscopic partial nephrectomy for renal cell carcinoma from June 2005 to June 2012 were retrospectively analyzed.The mean diameter of the renal tumors was 2.8 cm (range 0.7-7.9 cm).The clinical factors (i.e.gender,age,tumor characteristics),perioperative course (i.e.,operative time,warm ischemia time,estimated blood loss,and length of hospitalization),and early postoperative complications were collected and compared between the patients with tumor burdens ＞4.0 cm compared with those with tumor burdens of ≤4.0 cm.Results All the patients' surgical margins were negative.Patients with larger tumors had significantly greater tumor grades (P =0.017),collecting system repairing (72.5％ versus 34.9％,P=0.000),more intraoperative (13.7％ versus 3.9％,P=0.002) and postoperative complications (13.7％ versus 2.0％,P=0.000) and a significantly longer hospitalization (13.1±5.3 d versus 10.7±8.1 d,P=0.008).No other significant differences including warm ischemia time were noted between the 2 groups stratified by tumor size.Conclusion Retroperitoneal laparoscopic partial nephrectomy could be a feasible option for tumor burdens ＞4.0 cm to provide a nephron-sparing option for patients in whom lesions can be resected by individually assessed.
