3D腹腔镜在肾脏肿瘤保留肾单位手术中的应用优势

Clinical advantage of 3D laparoscopic nephron sparing surgery in renal neoplasm

摘要:

目的 探讨3D腹腔镜在肾脏肿瘤保留肾单位（NSS）手术中的应用优势。方法 收集2014年1月-2015年1月因肾脏肿瘤T1N0M0在该院行“保留肾单位手术”治疗45例患者的资料。其中，实施3D腹腔镜手术患者16例，2D腹腔镜手术患者29例。回顾性分析两种方式患者手术时间、术中出血量、肾蒂阻断时间及术后住院时间的临床差异。结果 两种手术方式患者均获得手术成功，3D腹腔镜手术组平均手术时间为（96.43±22.49）min、平均术中出血量（30.71±6.73）ml、平均肾蒂阻断时间（15.43±2.23）min、术后平均住院时间（6.00±1.00）d；2D腹腔镜手术组中平均手术时间为（120.67±30.10）min、平均术中出血量为（42.91±20.61）ml、平均肾蒂阻断时间（23.83±4.63）min、术后平均住院时间为（6.42±1.24）d。3D腹腔镜手术组的手术时间、肾蒂阻断时间和术中出血量均明显少于2D腹腔镜手术组（P <0.01）。两组间术后平均住院时间差异无统计学意义（P >0.05）。结论 3D腹腔镜在保留肾单位手术应用较传统2D有明显优势，它缩短了手术时间，降低了手术难度。在空间定位及深度感觉上优势明显，值得临床进一步推广应用。

Abstract:

【Objective】 To explore the advantage of 3D laparoscopic techniques in the application of nephron sparing surgery in renal neoplasm. 【Methods】 We retrospectively analyzed 45 cases (from Jan 2014 to Jan 2015) of laparoscopic nephron sparing surgery in renal neoplasm (T1N0M0). 16 cases accepted 3D laparoscopic nephron sparing surgery and 26 cases 2D laparoscopic nephron sparing surgery. We compared the operation duration, blood loss, time of renal pedicle clamp and the postoperative hospital time between the two groups. 【Results】 All patients were performed with laparoscopic surgery. 3D group have significantly superiority compared to 2D group in operation duration (96.43 ± 22.49) vs (120.67 ± 30.10) min, the blood loss (30.71 ± 6.73) vs (42.91 ± 20.61) ml and the time of renal pedicle clamp (15.43 ± 2.23) vs (23.83 ± 4.63) ml (P < 0.01). The postoperative hospital stay [3D: (6.00 ± 1.00) d vs 2D: (6.42 ± 1.24) d] have no difference between two group (P > 0.05). 【Conclusions】 3D laparoscopic techniques have superiority in the application of nephron sparing surgery in renal neoplasm. Surgical separation more accurate and suture more easy, and will be a promising procedure in the surgery of renal neoplasm.