| Objective:To evaluate the safety and efficacy of laparoscopic partial nephrectomy (LPN) for the treatment of renal tumors.Methods:A prospective randomized controlled trial was performed in our hopital from June2010to June2011.50cases were randomly divided into2groups:the laparoscopic partial nephrectomy group and the open partial nephrectomy (OPN) group. Tumor size, occlusion time, operative time, estimated blood loss, bed-ridden time, post-operative hospital stay, pre-operative and post-operative secrum creatinine, pre-operative and post-operative renal glomerular filtration rate (GFR), pre-operative and post-operative hemoglobin and post-operative VAS scores were compared between both groups. Otherwise, we divide the blocked-renal pedicle group into two groups as:clamping time≤30min group (39cases)and clamping time>30min group (11cases), and compared GFR of the operated kidney changes to evaluate the effect of ischemic time on renal function. The data were analyzed by the independent-sample T test、chi-square test and repeated measurement analysis of variance. P value less than0.05was regarded as statistically significance. Data were analyzed by SPSS17.0software.Results:All surgeries were successfully accomplished. There were no significant differences between the LPN and OPN groups in average tumor mean size (3.1±0.9cm vs3.6±1.0cm, respectively, P>0.05). There were no significant differences between the LPN and OPN groups in average occlusion time (22.99±8.73min vs22.96±10.69min, respectively, P>0.05). There were no significant differences between the LPN and OPN groups in average operative time (112.7±19.2vs115.8±17.4min, respectively, P>0.05). There were no significant differences between the LPN and OPN groups in estimated blood loss (73.0±26.3ml vs72.3±24.2ml, respectively, P>0.05). There were significant differences between the LPN and OPN groups in average bed-ridden time (4.4±1.7days vs3.3±1.9days, respectively, P<0.05). There were no significant differences between the LPN and OPN groups in average post-operative hospital stay (6.5±2.3days and6.4±2.8days, respectively, P>0.05). In the LPN group, the mean hemoglobin (Hb) level was154.0±19.6 g/L before NSS,131.8+15.8g/L1day after NSS,124.7±18.5g/L1wk after NSS, and134.2±14.56mo after NSS. In the OPN group, the mean hemoglobin (Hb) level was147.7±15.2g/L before NSS,132.7±13.6g/L1day after NSS,123.1±16.7g/L1wk after NSS, and140.8±11.4g/L6mo after NSS. There were no difference in the mean hemoglobin level before NSS,1day after NSS,1wk after NSS,6mo after NSS between LPN and OPN. P value is0.201,0.84,0.757and0.502。 In the LPN group, the mean serum creatinine level was74.5±11.2μmol/L before NSS,88.8±19.4μmol/L1day after NSS,83.8±15.2μmol/L1wk after NSS, and74.8±11.1μmol/L6mo after NSS. In the OPN group, the mean serum creatinine level was77.5±14.6μmol/L before NSS,92.1±19.1μmol/L1day after NSS,86.9±19.2μmol/L1wk after NSS, and79.3±15.8μmol/L6mo after NSS. There were no difference in the mean serum creatinine level before NSS,1day after NSS,1wk after NSS,6mo after NSS between LPN and OPN. P value is0.427,0.550,0.541and0.273. In the LPN group, the mean GFR level in operated side was45.8±8.7ml/min before NSS,28.8±10.5ml/min1wk after NSS, and43.3±8.6ml/min6mo after NSS. In the OPN group, the mean GFR level in operated side was42.3±8.7ml/min before NSS,29.5±8.6ml/min1wk after NSS, and40.0±8.3ml/min6mo after NSS. There were no difference in the mean GFR level before NSS,1day after NSS,1wk after NSS,6mo after NSS between LPN and OPN. P value is0.172.0.172and0.759respectively.There were significant differences between the LPN and OPN groups in VAS scores1day after NSS (5.2±1.6scores vs6.3±1.8scores, respectively, P<0.05). There were significant differences between the LPN and OPN groups in VAS scores1wk after NSS (3.3±1.5scores vs2.5±1.1scores, respectively, P<0.05). There were no significant differences between the LPN and OPN groups in the total risk of perioperative complications after NSS (1/20(5.0%)scores vs1/30(3.3%) scores, respectively, P<0.05). There were no recurrence or death who were followed for a mean duration of9.3months (range,6-12months)and renal function is normal during the follow up. The change of GFR lwk after NSS and GFR6mo after NSS in renal pedicle clamping time≤30min group was significantly different from that in the clamping time>30min group (P=0.002, P=0.07).[Conclusion] LPN for the treatment of renal tumors could be a safe and effective treatment option. LPN is the same safe and efficient surgery for the treatment of localized renal tumors as OPN. The damage on renal function could be minimal when the renal artery clamping time is controlled to with30min in the LPN surgery... |
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