Comparative analysis of the therapeutic effects of laparoendoscopic single-site partial nephrectomy: rectus abdominis and umbilicus
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摘要: 目的 对比分析经腹直肌旁与经脐不同入路单孔腹腔镜肾部分切除术的临床疗效及安全性。方法 回顾性分析2020年7月—2024年6月在南方医科大学第三附属医院接受单孔腹腔镜肾部分切除术的30例肾肿瘤患者的临床资料，其中经腹直肌旁单孔腹腔镜组10例，经脐单孔腹腔镜组20例。对2组患者的围手术资料、手术并发症及术后随访情况进行对比分析。结果 所有患者均顺利完成手术，术中未发生中转开放手术的情况。经脐单孔腹腔镜组中有2例术中增加了辅助孔。所有患者均未出现切缘阳性、漏尿、急性肾功能不全等并发症。2组年龄、性别和体重指数等一般情况比较差异无统计学意义(P>0.05)。经腹直肌旁单孔腹腔镜组与经脐单孔腹腔镜组手术时间[(127.4±21.7) min vs (133.6±23.0) min]、术中出血量[(185.0±224.9) mL vs (263.5±210.7) mL]比较均差异无统计学意义(P>0.05)。经腹直肌旁单孔腹腔镜组较经脐单孔腹腔镜组在肾脏热缺血时间[(23.5±3.0) min vs (28.3±9.1) min]及术后24 h疼痛评分[(2.6±0.7)分vs (3.6±1.1)分]等方面均具有优势(P < 0.05)。结论 经腹直肌旁与经脐不同入路单孔腹腔镜肾部分切除术安全、可行、疗效佳；经腹直肌旁较经脐单孔腹腔镜肾部分切除术在肾脏热缺血及术后疼痛方面有一定的优势，是一种可选择的手术方式。Abstract: Objective To compare and analyze the clinical efficacy and safety of laparoendoscopic single-site(LESS) partial nephrectomy performed through different approaches: the rectus abdominis and the umbilicus.Methods A retrospective analysis was conducted on the clinical data of 30 patients with renal tumors who underwent LESS partial nephrectomy at our institution from July 2020 to June 2024. Among these patients, 10 were assigned to the rectus abdominis LESS group, while 20 were assigned to the umbilical LESS group. A comparative analysis was performed on perioperative data, surgical complications, and postoperative follow-up between the two groups.Results All surgeries were completed successfully without any conversions to open surgery. In the umbilical LESS group, two patients required the additional an auxiliary port during the procedure. No patients experienced complications such as positive surgical margins, urinary leakage, or acute renal insufficiency. There were no statistically significant differences in demographic characteristics, including age, gender, and body mass index, between the two groups(P>0.05). The average surgical time for the rectus abdominis LESS group was (127.4±21.7) minutes, compared to (133.6±23.0) minutes for the umbilical LESS group. Intraoperative blood loss averaged (185.0±224.9) milliliters for the rectus abdominis group and (263.5±210.7) milliliters for the umbilical group, and no statistically significant difference observed(P>0.05). However, the rectus abdominis approach group had statistically significant advantages in renal warm ischemia time([23.5±3.0] min vs [28.3±9.1] min) and 24-hour postoperative pain scores([2.6±0.7] vs [3.6±1.1], P < 0.05).Conclusion Both the rectus abdominis and the umbilicus approaches for single-port laparoscopic partial nephrectomy are safe, feasible, and effective. The rectus abdominis approach offers certain advantages in terms of renal warm ischemia and postoperative pain compared to the umbilicus approach, making it a viable surgical option.
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Key words:
- laparoendoscopic single-site /
- partial nephrectomy /
- clinical efficacy
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表 1 2组患者术前一般情况比较
例(%)，X±S 项目 经腹直肌旁单孔腹腔镜组(10例) 经脐单孔腹腔镜组(20例) P值 年龄/岁 59.4±13.5 51.3±11.3 0.121 性别 0.442 男 6(60.0) 8(40.0) 女 4(40.0) 12(60.0) BMI/(kg/m2) 24.9±3.6 23.8±3.2 0.396 部位 0.245 左侧 3(40.0) 12(40.0) 右侧 7(60.0) 8(60.0) 肿瘤大小/cm 3.5±1.0 3.5±1.5 0.957 
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表 2 2组术中及术后相关指标比较例(%)，X±S
指标 经腹直肌旁单孔腹腔镜组(10例) 经脐单孔腹腔镜组(20例) P值 手术时间/min 127.4±21.7 133.6±23.0 0.482 术中出血量/mL 185.0±224.9 263.5±210.7 0.370 热缺血时间/min 23.5±3.0 28.3±9.1 0.044 术后VAS评分/分 2.6±0.7 3.6±1.1 0.002 切口满意度评分/分 3.3±0.5 3.9±0.7 0.006 术后相关并发症 1(10.0) 3(15.0) 0.698 出血 1(10.0) 2(10.0) 漏尿 0(0) 0(0) 急性肾功能不全 0(0) 0(0) 输尿管梗阻 0(0) 0(0) 感染 0(0) 1(5.0) 病理切缘阳性 0(0) 0(0)
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