后腹腔镜下肾下极入路根治性肾切除术:一种新的肾蒂血管处理方法。

Lower pole approach in retroperitoneal laparoscopic radical nephrectomy: a new approach for the management of renal vascular pedicle.

机构信息

Department of Urology, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, China.

出版信息

World J Surg Oncol. 2018 Feb 17;16(1):31. doi: 10.1186/s12957-018-1324-7.

DOI:10.1186/s12957-018-1324-7

PMID:29454352

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5816350/

Abstract

BACKGROUND

The objective of this study was to examine the effectiveness and safety of lower pole (LP) approach in retroperitoneal laparoscopic radical nephrectomy (LRN).

METHODS

One hundred thirty-two renal cancer patients were scheduled for selective retroperitoneal LRN. The surgery parameters and outcomes were compared. Out of 132 patients, 78 (59.1%) patients underwent LRN via LP approach, while 54 (40.9%) patients underwent LRN via lateroposterior space (LPS) approach.

RESULTS

Compared to LPS group, the LP group had a higher body mass index (27.0 ± 1.7 kg/m vs. 24.5 ± 1.8 kg/m, P < 0.0001) and a larger tumor size (6.9 ± 3.5 cm vs. 4.1 ± 3.3 cm, P < 0.0001). The LP approach reduced the volumes of blood loss and transfusion significantly (135.3 ± 17.2 mL vs. 219.6 ± 30.9 mL, P < 0.0001; 55.6 ± 28.3 vs. 141.1 ± 50.4 mL, P < 0.0001) as compared to the LPS approach. The LP approach also decreased the risk of conversion to open procedure (1.3 vs. 7.4%, P < 0.05).

CONCLUSIONS

The LP approach is an effective and safe alternative to the LPS approach for retroperitoneal LRN and might be more suitable for patients with obesity, large tumors, tumors located at the medial part of the kidney, or renal pedicular adhesion.

摘要

背景

本研究旨在探讨后腹腔镜根治性肾切除术（LRN）中肾下极（LP）入路的有效性和安全性。

方法

132 例肾癌患者行选择性后腹腔镜 LRN，比较手术参数和结果。132 例患者中，78 例（59.1%）采用 LP 入路行 LRN，54 例（40.9%）采用后外侧空间（LPS）入路行 LRN。

结果

与 LPS 组相比，LP 组患者的体质量指数（27.0±1.7 kg/m 2 比 24.5±1.8 kg/m 2 ，P<0.0001）更高，肿瘤体积更大（6.9±3.5 cm 比 4.1±3.3 cm ，P<0.0001）。LP 入路显著减少术中出血量和输血量（135.3±17.2 ml 比 219.6±30.9 ml ，P<0.0001；55.6±28.3 ml 比 141.1±50.4 ml ，P<0.0001）。与 LPS 入路相比，LP 入路降低了中转开放手术的风险（1.3%比 7.4%，P<0.05）。