Crouzet Sebastien, Chopra Sameer, Tsai Sheaumei, Kamoi Kazumi, Haber Georges-Pascal, Remer Erick M, Berger Andre K, Gill Inderbir S, Aron Monish
1 Department of Urology, Edouard Herriot Hospital , Lyon, France .
J Endourol. 2014 Oct;28(10):1202-7. doi: 10.1089/end.2013.0782. Epub 2014 Jul 21.
To determine the occurrence of flank symptoms, flank muscle atrophy, bulge, and hernia formation after open and laparoscopic partial nephrectomy (LPN).
Our prospective Institutional Review Board-approved database was queried to identify 50 consecutive patients who were treated with open partial nephrectomy (OPN) and 50 consecutive patients who were treated with LPN between September 2006 and May 2008. Study patients had: Solitary clinical T1 renal tumor, preoperative and ≥6 month postoperative CT scan performed at our institution, and a confirmed renal-cell carcinoma on the final pathology report. Patients with previous abdominal surgery and neuromuscular disorders were excluded. Oncocare software was used to measure abdominal wall musculature on preoperative and postoperative CT scan. Bilateral flanks were compared for muscle volume, bulge, and hernia. Patients were administered a phone questionnaire to assess postoperative flank symptoms.
No statistical significant difference was found in the demographics between the two groups. Median age (range) was 59.9 years (20.6-80.7) in the OPN group and 57.5 years (25-78) in the LPN group (P=0.89). Median (range) body mass index and American Society of Anesthesiologists scores were similar between the two groups. On CT scans, median percent variation (range) in abdominal wall muscle volume was significantly greater in the OPN group: -1.03% (-31.4-1.5) vs-0.39% (-5.2-1.8) (P=0.006). The median extent of flank bulge on CT scans (range) was also greater in the OPN group: 0.75 cm (-1.9-7.6) vs 0 cm (-2.7-2.8) (P=0.0004). The OPN group was also more symptomatic, including paresthesia 48% vs 8% (P=0.0053); numbness 44% vs 0% (P=0.002); and flank bulge 57% vs 12% (P=0.007).
Minimally invasive partial nephrectomy has lesser deleterious impact on flank muscle volume compared with OPN with fewer symptoms of flank bulge, paresthesia, and numbness.
确定开放性和腹腔镜下部分肾切除术（LPN）后胁腹症状、胁腹肌肉萎缩、膨出及疝形成的发生率。
查询我们前瞻性的、经机构审查委员会批准的数据库，以确定2006年9月至2008年5月期间连续接受开放性部分肾切除术（OPN）治疗的50例患者以及连续接受LPN治疗的50例患者。研究患者具备以下条件：孤立性临床T1期肾肿瘤、在我们机构进行了术前及术后≥6个月的CT扫描，且最终病理报告确诊为肾细胞癌。排除既往有腹部手术史和神经肌肉疾病的患者。使用Oncocare软件在术前和术后CT扫描上测量腹壁肌肉组织。比较双侧胁腹的肌肉体积、膨出及疝情况。对患者进行电话问卷调查以评估术后胁腹症状。
两组患者的人口统计学特征无统计学显著差异。OPN组的中位年龄（范围）为59.9岁（20.6 - 80.7岁），LPN组为57.5岁（25 - 78岁）（P = 0.89）。两组之间的中位（范围）体重指数和美国麻醉医师协会评分相似。在CT扫描上，OPN组腹壁肌肉体积的中位百分比变化（范围）显著更大：-1.03%（-31.4 - 1.5）对比-0.39%（-5.2 - 1.8）（P = 0.006）。OPN组CT扫描上胁腹膨出的中位程度（范围）也更大：0.75 cm（-1.9 - 7.6）对比0 cm（-2.7 - 2.8）（P = 0.0004）。OPN组的症状也更多，包括感觉异常48%对比8%（P = 0.0053）；麻木44%对比0%（P = 0.002）；以及胁腹膨出57%对比12%（P = 0.007）。
与OPN相比，微创部分肾切除术对胁腹肌肉体积的有害影响较小，胁腹膨出、感觉异常和麻木症状较少。
