CAJ | 학술논문

目的：观察肾肿瘤后腹腔镜肾部分切除术转手助腹腔镜手术的临床效果。方法选择2009年2月—2013年2月由单一术者完成的肾肿瘤后腹腔镜肾部分切除术中因粘连、出血、肿瘤位置复杂等原因改变术式的27例,随机分为手助腹腔镜组14例、开腹手术组13例,观察比较两组手术时间、出血量、切口长度、术后下床活动时间、住院时间、肾缺血时间等指标及并发症发生情况、预后,并比较两组C反应蛋白（CRP)及白细胞介素6（IL-6)浓度变化。结果本研究27例均顺利完成手术,手助腹腔镜组手术时间、出血量、切口长度、下床活动时间、住院时间均明显少于开腹手术组,差异均有统计学意义（P<0．01,P<0．05)；肾脏热缺血时间较开腹手术组稍长,两组比较差异无统计学意义（P>0．05)。术后1、3 d两组CRP及IL-6浓度均显著高于术前,但手助腹腔组术后CRP、IL-6浓度显著低于开腹手术组（P<0．01)。开腹手术组1例损伤腔静脉,术中修复,两组均无术后并发症发生。两组术后随访10~58个月,未发现肿瘤局部复发。结论肾肿瘤后腹腔镜肾部分切除术转手助腹腔镜手术创伤小、出血少、恢复快,安全可靠。
목적：관찰신종류후복강경신부분절제술전수조복강경수술적림상효과。방법선택2009년2월—2013년2월유단일술자완성적신종류후복강경신부분절제술중인점련、출혈、종류위치복잡등원인개변술식적27례,수궤분위수조복강경조14례、개복수술조13례,관찰비교량조수술시간、출혈량、절구장도、술후하상활동시간、주원시간、신결혈시간등지표급병발증발생정황、예후,병비교량조C반응단백（CRP)급백세포개소6（IL-6)농도변화。결과본연구27례균순리완성수술,수조복강경조수술시간、출혈량、절구장도、하상활동시간、주원시간균명현소우개복수술조,차이균유통계학의의（P<0．01,P<0．05)；신장열결혈시간교개복수술조초장,량조비교차이무통계학의의（P>0．05)。술후1、3 d량조CRP급IL-6농도균현저고우술전,단수조복강조술후CRP、IL-6농도현저저우개복수술조（P<0．01)。개복수술조1례손상강정맥,술중수복,량조균무술후병발증발생。량조술후수방10~58개월,미발현종류국부복발。결론신종류후복강경신부분절제술전수조복강경수술창상소、출혈소、회복쾌,안전가고。
Objective To observe the clinical results of hand-assisted laparoscopic partial nephrectomy converted from retroperitoneal laparoscopy. Methods During 2009 Feb. And 2013 Feb. , 27 patients underwent retroperitoneal lapa-roscopy partial nephrectomy, and operative style conversion for adhesion, bleeding, complex tumor location, etc. Randomly divided into two groups, 14 cases were converted to hand-assisted laparoscopic, and 13 to open surgeries. The tumor sizes , surgery time, loss of blood, incision length, off bed time, postoperative hospital stay, and renal ischemia time, prognosis, and concentration of CRP and IL-6 were compare. Results All the 27 operations were performed successfully. The surgery time, bleeding amount, incision length and off bed time of hand-assisted laparoscopic group were all less than that of open sur-gery group(P<0. 01 or P<0. 05);but renal ischemia time was longer than that of open surgery group, and the differences showed no statistical significance( P>0. 05 ) . The concentration of CRP and IL-6 on postoperative 1 d and 3 d of the two groups were significantly higher than the preoperative level(P<0. 01), but The concentration of CRP and IL-6 post-operation of hand assisted laparoscopic group were significantly lower than that of open surgery group (P<0. 01). In the open operation group there was 1 case of vena cava injury, and after intraoperative repair, patients of two groups had no complications after. Two groups were followed up for 10-58 months, no recurrence was found. Conclusion Retroperitoneal laparoscopy partial ne-phrectomy converted into hand-assisted laparoscopic is less invasive with less loss of blood but a quicker recovery.