Transperitoneal versus retroperitoneal laparoscopic radical nephrectomy: A comparative study
Transperitoneal versus retroperitoneal laparoscopic radical nephrectomy: A comparative study
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DOI：
10.1111/j.1442-2042.2008.02219.x
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发表时间：
2009-03-01
影响因子：
2.6
通讯作者：
Kanayama, Hiro-omi
中科院分区：
文献类型：
--
作者：
Taue, Ryuichi;Izaki, Hirofumi;Kanayama, Hiro-omi
比较腹腔镜根治性肾切除术（LRN）中经腹膜和后腹膜入路的围手术期结局，并确定每种入路的选择标准。在7年的时间内，连续100例患者（中位年龄62岁，范围20-80岁）接受了LRN治疗临床分期为T1 a-T3 a的肾肿瘤。首选腹膜后入路。根据肿瘤特征选择经腹膜入路。33名患者接受了经腹膜入路，67名患者接受了腹膜后入路。回顾性分析33例行经腹腔腹腔镜根治性肾切除术（TLRN），67例行后腹腔镜根治性肾切除术（RLRN）的围手术期手术时间、术中出血量、并发症及病理资料。两组之间肿瘤大小（5.3 vs 3.0 cm，P < 0.0001）和临床T分期（TLRN组较高，P < 0.0001）差异有统计学意义。TLRN组的术中并发症包括心动过缓、气胸、肾静脉损伤和肾动脉损伤，RLRN组的术中并发症包括气胸。两组在手术时间、出血量和肿瘤分级方面无差异，腹膜后和经腹膜入路均获得了良好的手术效果。应根据肿瘤的大小和位置选择经腹膜入路，以尽量减少血管损伤。
To compare perioperative outcome of transperitoneal and retroperitoneal approaches during laparoscopic radical nephrectomy (LRN) and to identify selection criteria for each approach.Over a 7-year period, 100 consecutive patients (median age 62 years, range 20-80) underwent LRN for a renal tumor with clinical stage T1a-T3a. The first choice approach was retroperitoneal. The transperitoneal approach was chosen in selected cases based on tumor characteristics. Thirty-three patients underwent the transperitoneal approach, and 67 had the retroperitoneal approach. Perioperative parameters including operative time, blood loss and complications and pathology data were retrospectively analyzed.Overall, 33 transperitoneal laparoscopic radical nephrectomies (TLRN) and 67 retroperitoneal laparoscopic radical nephrectomies (RLRN) were carried out. There was a statistically significant difference between the two groups in terms of size (5.3 vs 3.0 cm, P < 0.0001) and clinical T stage (higher in the TLRN group, P < 0.0001) of the tumors. Intraoperative complications included bradycardia, pneumothorax, renal vein injury, and renal artery injury in the TLRN group, and pneumothorax in the RLRN group. There were no differences in terms of operative time, blood loss and tumor grade between the two groups.Retroperitoneal and transperitoneal approaches yielded excellent surgical outcomes. The transperitoneal approach should be chosen based on tumor size and location to minimize vascular injury.