经腰腹联合途径腹腔镜手术治疗肾肿瘤的临床研究
경요복연합도경복강경수술치료신종류적림상연구
Efficacy of trans-lumbar-and-peritoneally joint approach for renal neoplasms by laparoscopic surgery: a clinically prospective study
  • 万方数据
    中华泌尿外科杂志 중화비뇨외과잡지
    CHINESE JOURNAL OF UROLOGY
    2015年 1期 2-6 ,共5页

    杨璐%陈勇吉%高亮%李涛%朱育春%韩平%李响%范天勇%魏强

    양로%진용길%고량%리도%주육춘%한평%리향%범천용%위강

    腹腔镜%肾肿瘤%经腰腹联合途径%手术 腹腔鏡%腎腫瘤%經腰腹聯閤途徑%手術
    복강경%신종류%경요복연합도경%수술
    Laparoscope%Renal neoplasm%Trans-lumbar-and-peritoneally joint approach%Operation
    目的 探讨经腰腹联合途径腹腔镜手术治疗肾肿瘤的安全性和有效性. 方法 回顾性分析2007年1月至2013年12月收治的100例肾肿瘤患者的临床资料,根据肿瘤大小及手术方式分为4组.4 cm≤肿瘤直径＜7 cm患者60例,行经腰腹联合途径腹腔镜下肾部分切除术30例(A组),男17例,女13例.平均年龄(49.7±14.5)岁.体质量(65.2± 14.1) kg.肿瘤位于左侧16例,右侧14例.肿瘤大小(4.2±0.9)cm.经腹腔途径腹腔镜下肾部分切除术30例(B组),男16例,女14例.平均年龄(48.5±13.9)岁.体质量(63.9±15.0) kg.肿瘤位于左侧17例,右侧13例.肿瘤大小(4.3±1.0)cm.肿瘤直径≥7 cm患者40例,行经腰腹联合途径腹腔镜下根治性肾切除术20例(C组),男11例,女9例.平均年龄(52.3±13.1)岁.体质量(64.4±13.5) kg.肿瘤位于左侧12例,右侧8例.肿瘤大小(8.5±0.9)cm.经腹腔途径腹腔镜下根治性肾切除术20例(D组),男12例,女8例.平均年龄(53.5±12.8)岁.体质量(65.0±13.6) kg.肿瘤位于左侧10例,右侧10例.肿瘤大小(8.7±0.9)cm.4组手术均采用全麻,A、C组手术体位和操作步骤与经腹膜后途径腹腔镜手术基本相同,仅术中完全打开侧腹膜,连通腹腔和腹膜后腔,扩大手术操作空间. 结果 本研究100例手术均顺利完成,无中转开放.A、B组手术时间分别为(109.5±22.5)、(110.7±23.6) min,热缺血时间分别为(24.0±2.5)、(24.8±2.4) min,估计出血量分别为(61.0±17.0)、(70.0±15.5) ml,需输血例数分别为1、2例,术后恢复进食时间分别为(39.7±6.2)、(52.3±5.8)h,两组比较差异均无统计学意义(P＞0.05).C、D组手术时间分别为(100.8±21.4)、(106.4±20.5) min,估计出血量分别为(40.0±9.5)、(48.5±9.0) ml,均无输血病例,术后恢复进食时间分别为(41.3±6.4)、(53.7±5.2)h,两组比较差异均无统计学意义(P＞0.05).4组均未出现术中脏器损伤和术后肠梗阻等严重并发症,术后3.526.3 d出院.4组随访3～ 84个月,A组1例复发、B组1例新发均行根治性肾切除术后无瘤生存;C组无复发,2例出现肺转移,其中1例死亡,1例行靶向药物治疗6个月带瘤生存;D组无复发,2例因肺转移死亡.结论 经腰腹联合途径腹腔镜手术能够安全有效地完成肾部分切除术和根治性肾切除术,尤其适合位于腹侧或较大的肾肿瘤.
    목적 탐토경요복연합도경복강경수술치료신종류적안전성화유효성. 방법 회고성분석2007년1월지2013년12월수치적100례신종류환자적림상자료,근거종류대소급수술방식분위4조.4 cm≤종류직경＜7 cm환자60례,행경요복연합도경복강경하신부분절제술30례(A조),남17례,녀13례.평균년령(49.7±14.5)세.체질량(65.2± 14.1) kg.종류위우좌측16례,우측14례.종류대소(4.2±0.9)cm.경복강도경복강경하신부분절제술30례(B조),남16례,녀14례.평균년령(48.5±13.9)세.체질량(63.9±15.0) kg.종류위우좌측17례,우측13례.종류대소(4.3±1.0)cm.종류직경≥7 cm환자40례,행경요복연합도경복강경하근치성신절제술20례(C조),남11례,녀9례.평균년령(52.3±13.1)세.체질량(64.4±13.5) kg.종류위우좌측12례,우측8례.종류대소(8.5±0.9)cm.경복강도경복강경하근치성신절제술20례(D조),남12례,녀8례.평균년령(53.5±12.8)세.체질량(65.0±13.6) kg.종류위우좌측10례,우측10례.종류대소(8.7±0.9)cm.4조수술균채용전마,A、C조수술체위화조작보취여경복막후도경복강경수술기본상동,부술중완전타개측복막,련통복강화복막후강,확대수술조작공간. 결과 본연구100례수술균순리완성,무중전개방.A、B조수술시간분별위(109.5±22.5)、(110.7±23.6) min,열결혈시간분별위(24.0±2.5)、(24.8±2.4) min,고계출혈량분별위(61.0±17.0)、(70.0±15.5) ml,수수혈례수분별위1、2례,술후회복진식시간분별위(39.7±6.2)、(52.3±5.8)h,량조비교차이균무통계학의의(P＞0.05).C、D조수술시간분별위(100.8±21.4)、(106.4±20.5) min,고계출혈량분별위(40.0±9.5)、(48.5±9.0) ml,균무수혈병례,술후회복진식시간분별위(41.3±6.4)、(53.7±5.2)h,량조비교차이균무통계학의의(P＞0.05).4조균미출현술중장기손상화술후장경조등엄중병발증,술후3.526.3 d출원.4조수방3～ 84개월,A조1례복발、B조1례신발균행근치성신절제술후무류생존;C조무복발,2례출현폐전이,기중1례사망,1례행파향약물치료6개월대류생존;D조무복발,2례인폐전이사망.결론 경요복연합도경복강경수술능구안전유효지완성신부분절제술화근치성신절제술,우기괄합위우복측혹교대적신종류.
    Objective To explore the safety and efficacy of a new trans-lumbar-and-peritoneally joint (TLPJ) approach for treating renal cell carcinoma by laparoscopic operation.Methods From January,2007 to December,2013,one hundred patients with renal tumor were divided into 4 groups according to the size of tumors and operative approaches.And the clinic information was compared retrospectively.Group A (TLPJ laparoscopic partial nephrectomy) included 17 male and 13 female with average age (49.7±14.5) years old and average weight (65.2± 14.1) kg.The location of tumor included 16 in left kidney and 14 in right kidney.The mean size of tumor was (4.2±0.9) cm.Group B (trans-peritoneal laparoscopic partial nephrectomy) included 16 male and 14 female with average age (48.5±13.9) years old and average weight (63.9±15.0) kg.The location of tumor included 17 in left kidney and 13 in right kidney.The mean size of tumor was (4.3±1.0) cm.Forty patients with tumor size over than 7cm were divided into group C and group D.Group C (TLPJ laparoscopic radical nephrectomy) included 11 male and 9 female patients,with average age (52.3± 13.1) years old and average weight (64.4± 13.5) kg.The mean tumor size was (8.5±0.9) cm.12 tumors were located in the left kidney and 8 in right kidney.average tumor size.Group D (trans-peritoneal laparoscopic radical nephrectomy) included 12 male and 8 female patients with average age (53.5± 12.8) years old and average weight (65.0± 13.6) kg.10 tumors were located in the left kidney and 10 in right kidney.The average tumor size was (8.7±0.9) cm.General anesthesia was applied in all groups.The body position and the surgical approach in group A and C were similar to the retroperitoneal approach.However,the entire side peritoneum was opened to connect the retroperitoneal space with the abdominal space,which largely extended the operative space and was particularly appropriate for the manipulation of the tumors with large size or in special location.Results All patients experienced successful operation without the open approach conversion.For patients in group A and B,the operative duration were (109.5±22.5) and (110.7±23.6) mins.The time of warm ischemia were (24.0±2.5) and (24.8±2.4) min.The estimated blood loss (EBL) were (61.0± 17.0) and (70.0± 15.5) ml with one patient and two patients needed blood transfusion,respectively.The time for gastrointestinal function restoration were (41.3±6.4) and (53.7±5.2)h.There were no significant differences between the two groups in comparing those parameters mentioned above (P＞0.05).For patients in group C and D,the operative duration were (100.8±21.4) and (106.4± 20.5) min.The EBL were (40.0±9.5) and (48.5±9.0) ml without any case needed blood transfusion.The time for gastrointestinal function restoration were (39.7±6.2) and (52.3±5.8) h.There were no significant differences between the two groups in comparing those parameters mentioned above (P＞0.05).All patients gained a satisfactory recovery after a hospital stay of 3.5 to 6.3 days,without any severe postoperative complications,such as intra-abdominal organ injury and intestinal obstruction.During a follow up from 3 to 84 months,one patient was found recurrence in group A and a new occurrence of renal tumor appeared in one patient in group B.Both of them presented survivals of non-neoplasm after an immediately radical nephrectomy.In group C,no recurrence was reported.2 cases were diagnosed as pulmonary metastases,in which one died due to this disease.The other one survived with tumor after 6 months therapy of targeted drugs.Two cases died due to the pulmonary metastases in group D.Conclusions Partially or radically laparoscopic nephrectomy could be completed safely and efficiently with TLPJ approach.This approach is especially suitable for large renal neoplasms or the neoplasms nearby peritoneum.
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