经腹腔入路和经腹膜后入路在腹腔镜下保留肾单位肾肿瘤切除术中的应用效果

Application of transperitoneal and retroperitoneal laparoscopic nephron sparing renal tumor resection

摘要:

目的 比较经腹腔入路和经腹膜后入路在腹腔镜下保留肾单位手术（LNSS）中的应用效果。方法 选取2018年1月－2022年12月该院行LNSS的患者100例，按照手术方法不同，分为：经腹腔入路腹腔镜下保留肾单位手术（TLNSS）组（53例）和经腹膜后入路腹腔镜下保留肾单位手术（RLNSS）组（47例），比较两组患者围手术期相关指标、治疗前后肾功能指标、临床疗效和并发症发生情况。结果 TLNSS组手术时间、热缺血时间、肠道功能恢复时间和肾动脉阻断时间明显较RLNSS组长，差异均有统计学意义（P < 0.05）；两组患者术中出血量、引流管拔出时间和住院时间比较，差异均无统计学意义（P > 0.05）；两组患者术后血清胆碱酯酶（ChE）较术前升高，血尿素氮（BUN）和血肌酐（Scr）较术前降低，TLNSS组ChE明显低于RLNSS组，TLNSS组BUN和Scr明显高于RLNSS组，差异均有统计学意义（P < 0.05）；TLNSS组疾病控制率（DCR）和总体有效率（ORR）明显低于RLNSS组，差异均有统计学意义（P < 0.05）；TLNSS组并发症总发生率明显高于RLNSS组，差异有统计学意义（P < 0.05）。结论 RLNSS可明显缩短手术时间和热缺血时间，促进患者肠道功能和肾功能的恢复，提高临床疗效，降低并发症发生风险。值得临床应用。

Abstract:

Objective Compare the application effects of laparoscopic nephron sparing surgery (LNSS) with transperitoneal and retroperitoneal approaches.Methods 100 patients who underwent LNSS from January 2018 to December 2022 were selected and divided into two groups according to different surgical methods: 53 patients in the transperitoneal laparoscopic nephron sparing surgery (TLNSS) group and 47 patients in the retroperitoneal laparoscopic nephron sparing surgery (RLNSS) group. The perioperative treatment indexes, renal function indicators before and after treatment, clinical treatment efficacy, and incidence of complications were compared between the two groups.Result The surgical time, warm ischemia time, intestinal function recovery time, and renal artery occlusion time of the TLNSS group were significantly longer than those of the RLNSS group, the differences were statistically significant (P < 0.05). The intraoperative bleeding volume, drainage tube removal time, and hospitalization time of the TLNSS group were not statistically significant compared to the RLNSS group, the differences were not statistically significant (P > 0.05). After surgery, serum cholinesterase (ChE) in both groups increased compared to before surgery, while blood urea nitrogen (BUN) and serum creatinine (Scr) in both groups decreased compared to before surgery, ChE in the TLNSS group was significantly lower than that in the RLNSS group, while BUN and Scr in the TLNSS group were significantly higher than those in the RLNSS group, the differences were statistically significant (P < 0.05). The clinical treatment of disease control rate (DCR) and overall response rates (ORR) in the TLNSS group were significantly lower than those of the RLNSS group, the differences were statistically significant (P < 0.05). The incidence of total complications in the TLNSS group was significantly higher than that in the RLNSS group, the differences was statistically significant (P < 0.05).Conclusion The retroperitoneal approach of LNSS can significantly shorten surgical and warm ischemia time, promote intestinal and renal function recovery, improve efficacy, and reduce the risk of complications. It is worthy of clinical application.