腹腔镜与开放保留肾单位手术干预肾脏占位性疾病疗效及生存质量研究

目的：评价腹腔镜与开放保留肾单位手术在干预肾脏占位性疾病的疗效及远期生存质量方面的作用。方法纳入2009年6月至2011年6月在我院行肾部分切除术的肾脏占位性疾病患者65例，其中试验组（腹腔镜肾部分切除术组）35例和对照组（开放肾部分切除术组）30例。比较两组手术时间、术中肾蒂阻断时间、失血量、术后3d内血肌酐水平、胃肠功能恢复时间、术后并发症、住院时间等各项指标及远期生存质量量表SF-36评分。结果65例手术均顺利完成。腹腔镜组较对照组手术出血量少（50.6±20.3）ml vs.（308.6±95.6）ml]，胃肠功能恢复快（2.7±0.8）d vs.（3.8±1.3）d]，住院时间短（13.2±3.1）d vs.（16.4±4.3）d]；手术时间（122.1±55.6）min vs.（96.2±50.5）min]和术中肾蒂阻断时间（28.3±2.5）min vs.（18.3±8.2）min]较长，差异均有统计学意义（P＜0.05）。术后2年远期生存质量量表评分较对照组在情感职能（50.4±20.2 vs.42.7±11.3）、活力（56.3±23.2 vs.40.2±10.9）等项目上有一定提高（P＜0.05）。结论本研究显示腹腔镜手术与开放手术相比具有出血少，恢复快，住院时间短等优势。但是手术时间和术中肾脏血供阻断时间较长。

Comparison of clinical effects and quality of Life between laparoscopic partial nephrectomy and open partial nephrectomy

Objective To analysis clinical effects of laparoscopic partial nephrectomy and open partial nephrectomy. Methods 65 patients with renal space occupying lesions received partial nephrectomy in our hospital were selected from Jun 2009 to Jun 2011. They were divided into experimental group （n=35） and control group （n=30）. Variable analysis included operative time, intraoperative renal pedicle clamping time, amount of blood loss, serum creatinine level in 3 days, the recovery time of gastrointestinal function, postoperative complications, hospitalization time and SF-36 Scale score. Results All 65 patients were operated successfully. Compared with open group, the mean blood loss of laparoscopic group was less than which in the open group. Laparoscopic group had a faster recovery of gastrointestinal function and a shorter hospital stay. While compared with open group, laparoscopic group had a longer operative time and intraoperative renal pedicle clamping time. Meanwhile, the life quality of long-term has improved in some aspects. Conclusion Compared with open surgery, laparoscopic partial nephrectomy had less bleeding, faster recovery, shorter hospital stay and other advantages,but the operative time and intraoperative blood supply to the kidney blocked a long time.