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目的比较三维腹腔镜与标准腹腔镜下肾部分切除术的临床资料,探讨三维腹腔镜下肾部分切除术的安全性、可行性和优缺点。方法回顾性分析2012年1月—2015年3月收治的49例局限性肾肿瘤患者的临床资料,男31例、女18例,平均年龄为(55.5±12.5)岁,肿瘤位于左侧肾脏26例、右侧肾脏23例,手术入路为经腹腔途径16例、经后腹腔途径33例。根据手术方法将患者分为三维腹腔镜组(3D组,20例)和标准腹腔镜组(标准组,29例)。比较两组手术参与者的视觉满意度、操作适应度、头晕不适度、眼睛疲劳度评分。比较两组患者的手术时间、术中失血量、热缺血时间、术后肠道通气恢复时间、术后住院天数,以及两组术后1个月双侧肾脏肾小球滤过率(GFR)。结果两组手术均成功完成,无中转开放手术病例。3D组视觉满意度、操作适应度和总体满意度评分均显著高于标准组(P值均<0.05),两组间头晕不适度和眼部疲劳度评分的差异均无统计学意义(P值均>0.05)。两组间手术时间、术中失血量、术中热缺血时间、术后肠道通气恢复时间、术后住院天数和并发症发生率的差异均无统计学意义(P值均>0.05)。两组术后随访4~41个月,无1例患者发生复发和转移。两组术后1个月患侧肾脏GFR均较术前显著降低(P值均<0.05),健侧肾脏GFR均较术前显著升高(P值均<0.05);两组间患侧和健侧肾脏手术前后GFR差值的差异均无统计学意义(P值均>0.05)。结论应用三维腹腔镜技术行肾部分切除手术安全、可行;与标准腹腔镜相比,三维腹腔镜技术在视觉上和精细操作上可能具有一定的优势。
Objective To compare the clinical data of three-dimensional laparoscopic and standard laparoscopic partial nephrectomy to investigate the safety, feasibility, advantages and disadvantages of three-dimensional laparoscopic partial nephrectomy. Methods The clinical data of 49 patients with localized renal tumors who were admitted to our hospital from January 2012 to March 2015 were retrospectively analyzed. There were 31 males and 18 females, with an average age of (55.5 ± 12.5) years and tumors located in the left kidney For example, 23 cases of the right kidney, surgical approach for the trans-abdominal route in 16 cases, via the retroperitoneal route in 33 cases. The patients were divided into three-dimensional laparoscopic group (3D group, 20 cases) and standard laparoscopic group (29 cases) according to the surgical method. Visual satisfaction, operational fitness, dizziness, and eye fatigue scores were compared between the two groups. The operation time, intraoperative blood loss, warm ischemia time, postoperative intestinal ventilation recovery time, postoperative hospital stay, and bilateral renal glomerular filtration rate (GFR) were compared between the two groups ). Results The two groups of surgeries were successfully completed. No cases were transferred to open surgery. Visual satisfaction, operational fitness and overall satisfaction scores of 3D group were significantly higher than those of standard group (P <0.05), and there was no significant difference between the two groups in dizziness discomfort and eye fatigue score (P value All> 0.05). There was no significant difference in operative time, intraoperative blood loss, intraoperative warm ischemia time, postoperative intestinal ventilation recovery time, postoperative hospital stay and incidence of complications (P> 0.05). Two groups were followed up for 4 to 41 months, no recurrence and metastasis occurred in 1 patient. The GFR of ipsilateral kidney in the two groups at 1 month after operation was significantly lower than that before operation (all P <0.05), while the GFR in contralateral kidney was significantly higher than that before operation (all P <0.05) There was no significant difference in GFR before and after contralateral kidney surgery (P> 0.05). Conclusions Three-dimensional laparoscopy is safe and feasible for partial nephrectomy. Compared with standard laparoscopy, three-dimensional laparoscopy may have some advantages in visual and fine operation.