【摘要】 目的探讨传统开放性肾癌根治性切除术与后腹腔镜肾癌根治性切除术治疗肾癌的临床疗效及其对患者术后肾功能的影响。方法根据手术方法的不同将100例肾癌患者分为观察组和对照组,每组50例。对照组采用传统开放性肾癌根治性切除术,观察组采用后腹腔镜肾癌根治性肾切除术。比较两组患者的围手术期指标变化情况、炎性因子水平和术后并发症发生情况。随访12个月,观察两组患者的肾功能变化情况。结果观察组患者的手术时间、术后肠功能恢复时间、引流管留置时间和术后住院时间均短于对照组患者,术中出血量少于对照组患者(P﹤0.05)。术后24 h、3个月、6个月、12个月,两组患者的血尿素氮(BUN)水平均高于本组术前,血肌酐(SCr)水平低于本组术前(P﹤0.05),但两组患者的BUN、SCr水平组间比较,差异均无统计学意义(P﹥0.05)。术后24 h,两组患者的白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平均明显高于本组术前,但观察组患者的IL-6、TNF-α水平均明显低于对照组患者(P﹤0.01)。观察组患者的术后并发症总发生率低于对照组患者(P﹤0.05)。结论后腹腔镜肾癌根治性切除术和传统开放性肾癌根治性切除术在治疗肾癌的过程中均对肾功能的损伤较小;与传统开放性肾癌根治性切除术相比,后腹腔镜肾癌根治性切除术具有术后恢复快、并发症少等优势,值得临床推广应用。更多还原

【Abstract】 Objective To investigate the clinical efficacy of traditional open radical nephrectomy and retroperitoneal laparoscopic radical nephrectomy for patient with renal carcinoma and their impact on postoperative renal function. MMeetthh-od A total of 100 patients with renal carcinoma were divided into observation group and control group according to different methods of surgery with 50 cases in each group. The control group was treated with traditional open radical nephrectomy while the observation group was treated with retroperitoneal laparoscopic radical nephrectomy. The changes in perioperative indicators, the levels of inflammatory factors and incidence of postoperative complication were compared in the two groups, and the variation of postoperative renal function were observed for 12 months during follow-up. Result The operation time, postoperative bowel function recovery time, drainage tube placement time and postoperative hospitalization time were significantly shorter in observation group, and the intraoperative bleeding volume was significantly decreased compared with the control group(P<0.05). The levels of BUN in the two groups significantly increased and levels of SCr were significantly decreased at 24 hours, 3 months, 6 months and 12 months after operation than before(P<0.05), but there was no significant difference in levels of BUN and SCr between the two groups(P>0.05). The levels of IL-6 and TNF-α in the two groups significantly increased at 24 hours after operation than before, and those in observation group was significantly lower than that in control group(P<0.01). The incidence of postoperative complication in observation group was significantly lower than that in control group(P<0.05). Conclusion Retroperitoneal laparoscopic radical and traditional open radical nephrectomy both had small effect on renal function in the treatment for patients with renal cancer. Retroperitoneal laparoscopic radical nephrectomy takes the advantages of faster recovery, fewer complications and better safety and effectiveness compared with traditional open radical nephrectomy.更多还原