腹腔镜肾部分切除术治疗孤立肾肿瘤的安全性和有效性
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摘要
目的:探讨腹腔镜肾部分切除术治疗孤立肾肿瘤的安全性和有效性。方法:采用随机数字法将60例孤立肾肿瘤患者均分为对照组和观察组,对照组患者行开放性肾部分切除术,观察组患者行腹腔镜肾部分切除术;记录两组患者手术时间、术中出血量、热缺血时间及术后肠道运动功能恢复时间、开始进食时间及引流时间,测定两组患者手术前、术后1周后血清胱抑素(CysC)、尿素(UREA)、血清肌酐(ScR)、尿酸(UA)、血β2-微球蛋白(β2-MG)及肾小球过滤率等肾功能指标;采用视觉模拟量表(VAS)评估两组患者术后2、8及12 h的疼痛情况,并记录止痛药物使用量、住院时间、住院费用及并发症发生情况。结果:观察组患者术中出血量、热缺血时间明显短于对照组(P<0.05);观察组患者术后肠道运动功能恢复时间、开始进食时间、引流时间均较对照组明显缩短;术后1周两组患者各项肾功能指标均明显低于术前,且观察组患者CysC、ScR、UA及β2-MG水平明显低于对照组,差异有统计学意义(P<0.05);观察组患者术后肾小球滤过率明显高于对照组,术后2、8、12 h时VAS评分及止痛药使用量均明显低于对照组,住院时间较对照组明显缩短、住院费用明显降低、并发症发生率明显降低,两组比较差异有统计学意义(P<0.05)。结论:采用腹腔镜肾部分切除术治疗孤立肾肿瘤,患者术中出血量少、热缺血时间较短,有利于患者肾功能恢复,是一种安全有效的治疗方式。
Objective:To investigate the safety and effectiveness of heminephrectomy in the treatment of isolated renal tumor.Methods:60 cases of isolated renal tumor were divided into two groups(n=30) by random number method.The patients in the control group underwent open heminephrectomy,and the observation group only underwent laparoscopic heminephrectomy.The related indicators and prognosis of the two groups were compared.Two groups of patients were recorded with operation time,intraoperative blood loss,thermal ischemia time and postoperative intestinal movement function recovery time,start time of food intake,and the drainage time.They were also measured with renal function indicators before and after operation including serum inhibition(CysC),urea(UREA),serum creatinine(ScR),uric acid(UA),blood beta 2-microglobulin(beta 2-MG) and glomerular filtration rate.Visual analogue scale(VAS) was used to evaluate the pain degrees of patients in the two groups at 2,8 and 12 hours after surgery,and the painkiller usage,hospitalization time,hospitalization expenses and complications were recorded.Results:Intraoperative blood loss and duration of thermal ischemia were significantly shorter in the observation group than in the control group,the difference between them was statistically significant(P<0.05).Start time of food intake,the time of intestinal recovery and the time of drainage in the observation group were significantly lower than those of the control group.After the operation,the two groups of renal function indicators were obviously lower than those before the operation,and the levels of CysC,ScR,UA and beta 2-MG in the observation group were obviously lower than those of the control group,the difference between them was statistically significant(P<0.05).The postoperative glomerular filtration rate of the observation group was significantly higher than that of the control group at 2,8,and 12 hours.VAS score and painkiller usage were significantly lower than those of the control group.The time of hospitalization in the observation group was obviously shortened,the cost of hospitalization was obviously reduced and the incidence of complications was obviously reduced.The difference between the two groups was statistically significant(P<0.05).Conclusion:The amount of bleeding in the patients is less and the time of thermal ischemia is shorter by laparoscopic heminephrectomy for the treatment of isolated renal tumors,it is a safe and effective treatment for the patients to improve renal function recovery.
Objective:To investigate the safety and effectiveness of heminephrectomy in the treatment of isolated renal tumor.Methods:60 cases of isolated renal tumor were divided into two groups(n=30) by random number method.The patients in the control group underwent open heminephrectomy,and the observation group only underwent laparoscopic heminephrectomy.The related indicators and prognosis of the two groups were compared.Two groups of patients were recorded with operation time,intraoperative blood loss,thermal ischemia time and postoperative intestinal movement function recovery time,start time of food intake,and the drainage time.They were also measured with renal function indicators before and after operation including serum inhibition(CysC),urea(UREA),serum creatinine(ScR),uric acid(UA),blood beta 2-microglobulin(beta 2-MG) and glomerular filtration rate.Visual analogue scale(VAS) was used to evaluate the pain degrees of patients in the two groups at 2,8 and 12 hours after surgery,and the painkiller usage,hospitalization time,hospitalization expenses and complications were recorded.Results:Intraoperative blood loss and duration of thermal ischemia were significantly shorter in the observation group than in the control group,the difference between them was statistically significant(P<0.05).Start time of food intake,the time of intestinal recovery and the time of drainage in the observation group were significantly lower than those of the control group.After the operation,the two groups of renal function indicators were obviously lower than those before the operation,and the levels of CysC,ScR,UA and beta 2-MG in the observation group were obviously lower than those of the control group,the difference between them was statistically significant(P<0.05).The postoperative glomerular filtration rate of the observation group was significantly higher than that of the control group at 2,8,and 12 hours.VAS score and painkiller usage were significantly lower than those of the control group.The time of hospitalization in the observation group was obviously shortened,the cost of hospitalization was obviously reduced and the incidence of complications was obviously reduced.The difference between the two groups was statistically significant(P<0.05).Conclusion:The amount of bleeding in the patients is less and the time of thermal ischemia is shorter by laparoscopic heminephrectomy for the treatment of isolated renal tumors,it is a safe and effective treatment for the patients to improve renal function recovery.
引文
[1]王强,张旭.肾部分切除术治疗复杂性肾肿瘤的研究现状及进展[J].微创泌尿外科杂志,2016,5(5):314-320.
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[4]WU Z,XU Y,YU J,et al.Laparoendoscopic single-site retroperitoneoscopic nephrectomy for giant hydronephrosis[J].J Endourol,2014,28(11):1328-1332.
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[9]郑沛,王东文.后腹腔镜肾部分切除术治疗早期肾肿瘤的疗效与术后并发症分析[J].中国卫生标准管理,2017,8(4):38-40.
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[11]CHANTADA C,GARCIR-TELLO A,ESQUINAS C,et al.Comparative study of multiport laparoscopy and umbilical laparoendoscopic single-site surgery with reusable platform for treating renal masses[J].Actas Urol Esp,2017,41(1):39-46.
[12]张万生,王立国,于航,等.后腹腔镜肾部分切除术治疗肾肿瘤的疗效及安全性分析[J].中国现代医学杂志,2017,27(23):87-90.
[13]王勇.后腹腔镜与开放手术行肾部分切除术治疗肾肿瘤效果的调查研究[J].中国卫生产业,2016,13(36):164-166.
[14]黄道光,连惠波,甘卫东.超声引导下冷冻消融术治疗孤立肾肾盂肿瘤1例报告及文献复习[J].临床泌尿外科杂志,2015,30(3):222-225.
[15]TACHIBANA H,KONDO T,TAKAGI T,et al.Impact of preoperative proteinuria on renal functional outcomes after open partial nephrectomy in patients with a solitary kidney[J].Investig Clin Urol,2017,58(6):409-415.
[16]刘建舟,罗晓辉,门群利,等.腹腔镜保留肾单位手术治疗复杂性肾肿瘤中倒刺缝合对热缺血时间及并发症的影响[J].腹腔镜外科杂志,2016,21(8):627-630.
[17]AMASYALI AS,ATES E,KAZICI H G,et al.Laparoscopic Dismembered Pyeloplasty in a Solitary Kidney with Intrarenal Pelvis:Two Challenges in One Case[J].Case Rep Urol,2017,2017:8169208.
[18]LIN F,ZHANG C,ZHANG Q,et al.Uniportal videoassisted thoracoscopic lobectomy:An alternative surgical method for pulmonary carcinoma[J].Pakistan Journal of Medical Sciences,2016,32(5):1283-1285.
[2]HANDMER M M,LOUIE-JOHNSUN M.LESS(laparoendoscopic single-site)nephrectomy:do the technical challenges make it MORE[J].ANZ J Surg,2016,86(9):728-729.
[3]杨全成,孙艳.孤立肾肾癌肾部分切除术后并发症与肿瘤的预后分析[J].临床泌尿外科杂志,2016,31(11):991-993.
[4]WU Z,XU Y,YU J,et al.Laparoendoscopic single-site retroperitoneoscopic nephrectomy for giant hydronephrosis[J].J Endourol,2014,28(11):1328-1332.
[5]BANSAL D,COST N G,BEAN C M,et al.Pediatric laparo-endoscopic single site partial nephrectomy:feasibility in infants and small children for upper urinary tract duplication anomalies[J].J Pediatr Urol,2014,10(5):859-863.
[6]解放,丁森泰,牛志宏,等.术中超声辅助下行孤立肾肾癌保留肾单位手术效果观察[J].临床泌尿外科杂志,2013,28(1):1-5.
[7]JUNG J W,CHA W H,LEE B K,et al.Laparoendoscopic single-site surgery using innovative articulating instruments:preclinical evaluation of the prototype[J].JEndourol,2014,28(3):281-285.
[8]BREDA A,SCHWARTZMANN I,EMILIANI E,et al.Mini-laparoscopic live donor nephrectomy with the use of3-mm instruments and laparoscope[J].World J Urol,2015,33(5):707-712.
[9]郑沛,王东文.后腹腔镜肾部分切除术治疗早期肾肿瘤的疗效与术后并发症分析[J].中国卫生标准管理,2017,8(4):38-40.
[10]PIGNOT G,MEJEAN A,BERNHARD J C,et al.The use of partial nephrectomy:results from a contemporary national prospective multicenter study[J].World J Urol,2014,33(1):33-40.
[11]CHANTADA C,GARCIR-TELLO A,ESQUINAS C,et al.Comparative study of multiport laparoscopy and umbilical laparoendoscopic single-site surgery with reusable platform for treating renal masses[J].Actas Urol Esp,2017,41(1):39-46.
[12]张万生,王立国,于航,等.后腹腔镜肾部分切除术治疗肾肿瘤的疗效及安全性分析[J].中国现代医学杂志,2017,27(23):87-90.
[13]王勇.后腹腔镜与开放手术行肾部分切除术治疗肾肿瘤效果的调查研究[J].中国卫生产业,2016,13(36):164-166.
[14]黄道光,连惠波,甘卫东.超声引导下冷冻消融术治疗孤立肾肾盂肿瘤1例报告及文献复习[J].临床泌尿外科杂志,2015,30(3):222-225.
[15]TACHIBANA H,KONDO T,TAKAGI T,et al.Impact of preoperative proteinuria on renal functional outcomes after open partial nephrectomy in patients with a solitary kidney[J].Investig Clin Urol,2017,58(6):409-415.
[16]刘建舟,罗晓辉,门群利,等.腹腔镜保留肾单位手术治疗复杂性肾肿瘤中倒刺缝合对热缺血时间及并发症的影响[J].腹腔镜外科杂志,2016,21(8):627-630.
[17]AMASYALI AS,ATES E,KAZICI H G,et al.Laparoscopic Dismembered Pyeloplasty in a Solitary Kidney with Intrarenal Pelvis:Two Challenges in One Case[J].Case Rep Urol,2017,2017:8169208.
[18]LIN F,ZHANG C,ZHANG Q,et al.Uniportal videoassisted thoracoscopic lobectomy:An alternative surgical method for pulmonary carcinoma[J].Pakistan Journal of Medical Sciences,2016,32(5):1283-1285.