Kercher K W, Heniford B T, Matthews B D, Smith T I, Lincourt A E, Hayes D H, Eskind L B, Irby P B, Teigland C M
Department of General Surgery, Carolinas Medical Center, 1000 Blythe Blvd., Charlotte, NC 28203, USA,
Surg Endosc. 2003 Dec;17(12):1889-95. doi: 10.1007/s00464-003-8808-3. Epub 2003 Oct 23.
Initially slow to gain widespread acceptance within the urological community, laparoscopic nephrectomy is now becoming the standard of care in many centers. Our institution has seen a dramatic transformation in practice patterns and patient outcomes in the 2 years following the introduction of laparoscopic nephrectomy. We compare the experience with laparoscopic and open nephrectomy within a single medical center.
Data were collected for all patients undergoing elective nephrectomy (live donor, radical, simple, partial, and nephroureterectomy) between August 1998 and September 2002. Data were analyzed by Wilcoxon rank sum, chi-square, and Fisher's exact test. A p-value <0.05 was considered significant.
Of the patients, 92 underwent open nephrectomy, and 118 were treated laparoscopically (87 hand-assisted laparoscopic nephrectomy, 31 totally laparoscopic). There was one conversion (0.8%). Patient demographics and indications for surgery were equivalent for both groups. Mean operative time for laparoscopic nephrectomy (230 min) was longer than for open (187 min, p = 0.0001). Blood loss (97 ml vs 216 ml, p = 0.0001), length of stay (3.9 days vs 5.9 days, p = 0.0001), perioperative morbidity (14% vs 31%, p = 0.01), and wound complications (6.8% vs 27.1%, p = 0.0001) were all significantly less for laparoscopic nephrectomy. For live donors, time to convalescence was less (12 days vs 33 days, p = 0.02), but hospital charges were more for patients treated laparoscopically (19,007 dollars vs 13,581 dollars, p = 0.0001).
Laparoscopic nephrectomy results in less blood loss, fewer hospital days, fewer complications, and more rapid recovery than open surgery. We believe that these benefits outweigh the higher hospital charges associated with the laparoscopic approach.
腹腔镜肾切除术在泌尿外科界最初获得广泛认可的速度较慢，如今在许多中心正成为治疗的标准方法。在引入腹腔镜肾切除术后的两年里，我们机构的实践模式和患者预后发生了显著转变。我们在单一医疗中心比较了腹腔镜肾切除术和开放性肾切除术的经验。
收集了1998年8月至2002年9月期间所有接受择期肾切除术（活体供肾、根治性、单纯性、部分性和肾输尿管切除术）患者的数据。数据采用Wilcoxon秩和检验、卡方检验和Fisher精确检验进行分析。p值<0.05被认为具有统计学意义。
患者中，92例行开放性肾切除术，118例行腹腔镜手术（87例手辅助腹腔镜肾切除术，31例完全腹腔镜手术）。有1例中转（0.8%）。两组患者的人口统计学特征和手术指征相当。腹腔镜肾切除术的平均手术时间（230分钟）长于开放性手术（187分钟，p = 0.0001）。腹腔镜肾切除术的失血量（97毫升对216毫升，p = 0.0001）、住院时间（3.9天对5.9天，p = 0.0001）、围手术期发病率（14%对31%，p = 0.01）和伤口并发症（6.8%对27.1%，p = 0.0001）均显著减少。对于活体供肾者，康复时间更短（12天对33天，p = 0.02），但腹腔镜手术患者的住院费用更高（19,007美元对13,581美元，p = 0.0001）。
与开放性手术相比，腹腔镜肾切除术导致的失血量更少、住院天数更少、并发症更少且恢复更快。我们认为这些益处超过了与腹腔镜手术相关的更高住院费用。
