【摘要】 目的比较开放性肾部分切除术、腹腔镜肾部分切除术和腹腔镜零阻断肾部分切除术三种不同术式对总肾功能和分肾功能的影响。方法选取2015年10月～2017年10月于哈尔滨医科大学附属肿瘤医院泌尿外一科行手术的肾癌患者共91例。其中,开放性肾部分切除术组(非腹腔镜组) 22例、腹腔镜肾部分切除术组(腹腔镜组) 62例和腹腔镜零阻断肾部分切除术组(零阻断组) 7例。对三组患者一般资料(年龄、性别、手术部位)、手术指征(肿瘤直径、核分级、手术时间、术中出血量、术后引流量、手术阻断时间、术后拔除肾周引流管时间、术后住院时间)以及肾功能指标:血肌酐水平(Scr)、尿素水平(BUN)、肾小球滤过率水平(GFR)等指标进行比较。结果三组间比较:患者的一般资料无统计学差异(P> 0. 05);手术指征中三组的肿瘤直径有明显的统计学差异(P <0. 001),其中非腹腔镜组最大;三组的手术时间有明显的统计学差异(P=0. 003),其中腹腔镜组手术时间最长;三组的手术阻断时间有明显的统计学差异(P <0. 001),其中腹腔镜组的手术阻断时间最长;三组的术后住院时间有统计学差异(P=0. 013),其中非腹腔镜组术后住院时间最长;核分级、术中出血量、术后引流量、术后拔出肾周引流管时间差异均无统计学意义(P> 0. 05);三组间手术前后检测指标差异均无统计学意义(P> 0. 05)。结论三种不同的肾部分切除术在术后肾功能的影响无明显区别。本研究为临床进行肾癌患者手术方式的选择提供了更多的参考数据。更多还原

【Abstract】 Objective To compare the effect of open partial nephrectomy,laparoscopic partial nephrectomy and laparoscopic renal pedicle without blocking the partial nephrectomy on total renal function and spilt renal function. Methods Ninety-one patients with renal malignant tumor were selected in Cancer Hospital of Harbin Medical University from October 2015 to October 2017 and divided into three groups according to nephrectomy types. Twenty-two cases were included in open partial nephrectomy,62 cases in laparoscopic partial nephrectomy and 7cases in laparoscopic renal pedicle without blocking the partial nephrectomy. The demographics of patients( age,sex,surgical site),operation indications( diameter of tumor,nuclear grade,operation time,intraoperative blood loss,postoperative drainage time,warm ischemia time,drainage tube removal time,postoperative hospital stay),and the renal function parameters( serum creatinine,blood urea nitrogen,glomerular filter rate) were compared among the three groups. Results There was no significant difference among the three groups on demographics of patients( P > 0. 05). There was statistically significant difference on diameter of tumor among the three groups( P < 0. 001),and the diameter of tumors in open partial nephrectomy was largest. There was statistically significant difference on operation time among the three groups( P = 0. 003),and the operation time of laparoscopic partial nephrectomy was longest.There was statistically significant difference on warm ischemia time among the three groups( P< 0. 001),and the warm ischemia time of laparoscopic partial nephrectomy was longest. There was statistically significant difference on postoperative hospital stay among the three groups( P =0. 013),and the postoperative hospital stay of open partial nephrectomy was longest. There were no significant differences among the three groups on nuclear grade,intraoperative blood loss,postoperative drainage time,drainage tube removal time( P > 0. 05). Preoperative and postoperative detection indexes has no significant difference among the three groups( P >0. 05). Conclusion Three different kinds of partial nephrectomy had no significant differences on postoperative renal functions. This work provides more reference data for the selection of surgical methods for patients with renal cancer.更多还原