Laparoscopic Nephron-sparing Surger Compared With Open Surgery

Purpose：Discussion Analysis laparoscopic nephron-sparing surgery and openpartial nephrectomy for the treatment of diameter <4cm kidney cancer clinical results.Methods: Select Binzhou City, Shandong Province, the city municipal hospitalclinical data January2010December201389cases of renal tumors treated patientswere retrospectively finishing, divided into two groups according to surgical approach,nephron-sparing surgery (laparoscopic chamber mirror group) and47cases of opensurgery (open group)42cases, two groups were compared operative time, blood loss,renal ischemia, gastrointestinal function recovery time, hospital stay, preoperative andpostoperative serum creatinine, occurrence of complications and patient follow-up afterdischarge for3-36months of tumor recurrence and metastasis.Results:1.Comparison of two groups of patients in age, sex, duration of illness, andother basic information, The difference was not statistically significant (P>0.05),Comparable (Table1); Pathological compare two groups of patients,11cases of benignlaparoscopic group (23.40%), renal cell carcinoma in36cases (76.60%),10cases ofbenign open group (23.81%), renal cell carcinoma in32cases (76.19%), between thetwo groups, the difference was not statistically significant (P>0.05), comparable;Patients in both groups were negative margin between the two groups, the differencewas not statistically significant (P>0.05), comparable.2. Two groups of patientsperioperative outcome measures comparison, the average operation time laparoscopygroup (109.72±32.46) min was significantly shorter than the open surgery group, the average time (128.35±27.88) min, the difference was statistically significant (P <0.05);chamber lens mean warm ischemia time (25.42±4.56) min above the open group, theaverage cold ischemia time (17.50±2.50) min, the difference was statisticallysignificant (P <0.05); Comparison of the two groups was found bleeding volumelaparoscopic group group (92.40±34.20) m1, significantly less than the open group(131.70±56.70) m1, the difference was statistically significant (P <0.05); Endoscopicpostoperative intestinal recovery time (1.6±0.4) d, postoperative hospital stay (9.4±1.8) d, were significantly shorter in the open group (3.6±1.3) d,(16.7±5.8) d, thedifference was statistically significance (P <0.05);Two groups of patients before andafter surgery three days of serum creatinine compared with laparoscopy group (89.6±11.67) umol/L,(94.4±12.3) umol/L, the open group (90.4±12.35) umol/L,(95.4.±11.3) umol/L, compared with no significant difference between the two groups (P>0.05). Laparoscopic group were successfully completed surgery without transfusion,hematuria and hematoma cases, surgery, one case of subcutaneous emphysema, twocases of peritoneal damage, but the symptoms are mild, not special treatment; Opengroup had three cases of intraoperative bleeding, blood transfusion>800m1, two caseof pleural injury, peritoneal injury in2cases, pleural and peritoneal given repair, threecases of postoperative wound infection, given antibiotics, drainage, after dressinghealed.All patients1d,7d review of renal function and electrolytes were unremarkable.Complications in the two groups were compared with laparoscopy group complicationrate6.38%, significantly lower than the open group23.81%, the difference wasstatistically significant (P <0.05). After the patient was discharged on renal cellcarcinoma patients, endoscopic group76.60%(36cases), the open group76.19%(32cases), were followed up for3-36months, mean follow-up endoscopic group18.7±4.3个month, open group mean follow-up18.6±4.4months, all patients were alive afterCT, B ultrasound or bone scan, patients were no metastases, local recurrence two caseslaparoscopy group, open group of local recurrence in3cases, two3-year disease-freesurvival in patients compared with laparoscopy group94.44%,90.63%open groupbetween the two groups, the difference was not statistically significant (P>0.05). Conclusion: Compared with open surgery, laparoscopic nephron-sparing surgerywith less blood loss, shorter operative time, less trauma, shorter hospital stay, fewercomplications, faster recovery and other advantages, but after controlling for tumorrecurrence and metastasis the ability to both similar.