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| 行3D腹腔镜与2D腹腔镜肾部分切除术的临床比较 |
| 谭海颂1,汤晓晖2,吴震杰1,鲍一1,时佳子1,刘冰1,何屹3,王林辉1* |
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(1. 第二军医大学长征医院泌尿外科, 上海 200003;
2. 上海市宝山区罗店医院泌尿外科, 上海 201908;
3. 浙江省嘉兴市第一医院泌尿外科, 嘉兴 314000
*通信作者) |
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| 摘要: |
| 目的 比较行3D腹腔镜与2D腹腔镜下肾部分切除术的临床疗效，探讨3D腹腔镜手术治疗肾肿瘤的优缺点。方法 回顾性分析2013年8月至2016年3月第二军医大学长征医院、长海医院同一手术组完成的134例行腹腔镜下肾部分切除术肾肿瘤患者的临床资料，其中3D腹腔镜组53例，2D腹腔镜组81例。比较两组患者的围手术期指标及随访资料，包括手术时间、术中出血量、术中输血率、肾动脉阻断热缺血时间、术后肠道恢复时间、术后住院时间、围手术期并发症及术前、术后双侧肾小球滤过率（GFR）。结果 两组手术均顺利完成，无中转开放或根治性肾切除手术病例，手术切缘均为阴性。3D腹腔镜组患者的手术时间[（193.40±45.14）vs（217.00±59.19）min，P=0.015]、肾动脉阻断热缺血时间[（23.70±6.96）vs（26.60±8.10）min，P=0.032]及经手术的患侧肾GFR下降值[（12.70±6.49）vs（15.10±6.45）mL·min-1·1.73 m-2，P=0.036）均优于2D腹腔镜组，而两组患者的术中出血量、术中输血率、术后肠道恢复时间、术后住院时间及围手术期并发症发生率差异均无统计学意义（P>0.05）。所有发生并发症患者予以保守对症治疗后均好转出院。术后随访1~32个月，无患者发生急、慢性肾功能不全，无患者出现局部肿瘤复发、远处转移或死亡。结论 与传统2D腹腔镜相比，行3D腹腔镜下肾部分切除术能够缩短手术时间和肾动脉阻断热缺血时间，有助于更好地保留肾功能。［关键词] 3D腹腔镜手术；肾部分切除术；肾肿瘤；肾功能 |
| 关键词: 3D腹腔镜手术 肾部分切除术 肾肿瘤 肾功能 |
| DOI：10.16781/j.0258-879x.2017.02.0239 |
| 投稿时间：2016-09-28修订日期：2016-12-07 |
| 基金项目:上海市“领军人才”计划项目（2013046），上海市青年科技英才扬帆计划（16YF1403600）. |
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| Clinical comparative analysis of 3D and 2D laparoscopic partial nephrectomy for renal tumors |
| TAN Hai-song1,TANG Xiao-hui2,WU Zhen-jie1,BAO Yi1,SHI Jia-zi1,LIU Bing1,HE Yi3,WANG Lin-hui1* |
(1. Department of Urology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China;
2. Department of Urology, Shanghai Baoshan Luo dian Hospital, Shanghai 201908, China;
3. Department of Urology, Jiaxing First Hospital, Jiaxing 314000, Zhejiang, China
*Corresponding author) |
| Abstract: |
| Objective To compare the clinical efficacies of 3D and 2D laparoscopic partial nephrectomy for renal tumors and to investigate the pros and cons of 3D laparoscopic partial nephrectomy. Methods We retrospectively analyzed the clinical data of 134 patients with renal tumors; they underwent laparoscopic partial nephrectomy between Aug. 2013 and Mar. 2016 by the same surgical group in Changhai Hospital and Changzheng Hospital, Second Military Medical University. Fifty-three cases were included in the 3D laparoscopic partial nephrectomy group and 81 cases in the 2D laparoscopic partial nephrectomy group. The perioperative and follow-up data subjected to comparison and analysis included operative time, estimated blood loss, intraoperative transfusion, warm ischemic time, recovery time of bowel function, length of hospitalization, perioperative complications, and pre-and post-operative glomerular filtration rate (GFR). Results All operation procedures of this study were completed uneventfully without conversion to open surgery or radical nephrectomy, and surgical margins were negative in all cases. The operative time ([193.40±45.14] vs[217.00±59.19] min, P=0.015), warm ischemic time ([23.70±6.96] vs[26.60±8.10] min, P=0.032) and decrease of GFR of the operated kidney ([12.70±6.49] vs[15.10±6.45] mL·min-1·1.73 m2, P=0.036) in the 3D group were significantly improved compared with those in the 2D group. However, the estimated blood loss, intraoperative transfusion, recovery time of bowel function, length of hospitalization and perioperative complications were not significantly different between the two groups (P>0.05). All the patients with complications were discharged from the hospital after conservative therapy. During a follow-up of 1-32 months, no patients had acute or chronic renal failure, local recurrence or distant metastasis, and there was no death case. Conclusion Compared with 2D laparoscopic partial nephrectomy, 3D laparoscopic technology can reduce operative time and warm ischemic time, which can help to better conserve renal function. |
| Key words: 3D laparoscopic surgery partial nephrectomy kidney neoplasms kidney function |
