Transumbilical versus retroperitoneal laparoendoscopic single-site partial nephrectomy: a comparison of perioperative outcomes
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摘要: 目的 比较经脐和经腹膜后2种入路方式行单孔腹腔镜肾部分切除术(laparoendoscopic single-site partial nephrectomy，LESS-PN)的围手术期临床效果。方法 回顾性分析2021年7月—2022年4月南京医科大学第二附属医院31例分别经脐(17例)或经腹膜后(14例)入路行LESS-PN肾癌患者的临床资料，比较两组术中手术时间、术中失血量、术后禁食时间及术后住院时间等围手术期临床指标。结果 经脐入路LESS-PN组手术时间为60~150 min，平均(98.8±21.3) min；经腹膜后入路LESS-PN组手术时间为45~120 min，平均(81.4±24.1) min，两组比较差异有统计学意义(P=0.041)。经脐入路LESS-PN组术中出血量为10~300 mL，平均(174.1±87.3) mL；经腹膜后入路LESS-PN组术中出血量为50~350 mL，平均(164.3±102.7) mL；两组比较差异无统计学意义(P=0.775)。经脐入路LESS-PN组术后禁食时间为2~6 d，平均(2.71±1.05) d；经腹膜后入路LESS-PN组为术后禁食时间为1~4 d，平均(2.07±0.92) d；两组比较差异无统计学意义(P=0.086)。经脐入路LESS-PN组术后住院时间为6~10 d，平均(6.82±1.01) d；经腹膜后入路LESS-PN组术后住院时间为5~9 d，平均(6.36±1.34) d；两组比较差异无统计学意义(P=0.278)。结论 经脐和经腹膜后入路行LESS-PN治疗T1a期肾肿瘤均有良好的围手术期效果，可根据肿瘤的具体位置选择合适的手术入路。Abstract: Objective To compare perioperative outcomes between transumbilical and retroperitoneal laparoendoscopic single-site partial nephrectomy (LESS-PN) for renal cell carcinoma (RCC) and to identify the indicators for each approach.Methods A total of 31 patients underwent transumbilical (n=17) or retroperitoneal (n=14) LESS-PN for RCC in Second Affiliated Hospital of Nanjing Medical University from July 2021 to April 2022. The operation time, blood loss during operation, fasting period after surgery and hospital stay were compared between the two groups.Results The operation time was 60-150 min (a mean of [98.8±21.3] min) for transumbilical approach LESS-PN and 45-120 min(a mean of [81.4±24.1] min) for retroperitoneal approach LESS-PN (P=0.041). The blood loss was 10-300 mL (a mean of [174.1±87.3] mL) for transumbilical approach LESS-PN and 50-350 mL (a mean of [164.3±102.7] mL) for retroperitoneal approach LESS-PN (P=0.775). The fasting period of surgery was 2-6 d (a mean of [2.71±1.05]d) for transumbilical approach LESS-PN and 1-4 d (a mean of [2.07±0.92] d) for retroperitoneal approach LESS-PN (P=0.086). The hospital stay was 6-10 d (a mean of [6.82±1.01] d) for transumbilical approach LESS-PN and 5-9 d (a mean of [6.36±1.34] d) for retroperitoneal approach LESS-PN (P=0.278).Conclusion Both transumbilical and retroperitoneal approaches can yield satisfactory perioperative outcomes in LESS-PN for RCC in stage T1a. The appropriate surgical approach can be selected according to the specific location of the tumor.
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表 1 经脐和经腹膜后入路患者临床一般资料比较
X±S 项目 经脐入路
LESS-PN组
(17例)经腹膜后入路
LESS-PN组
(14例)P 年龄/岁 57.0±14.7 56.5±14.5 0.925 性别/例 0.420 男 12 10 女 5 4 BMI/(kg·m-2) 24.9±2.0 25.3±1.6 0.621 肿瘤大小/cm 3.1±0.5 3.3±0.8 0.421 R.E.N.A.L.评分/分 3.9±1.0 4.4±1.2 0.180 
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