Department of Urology, King George Medical University (also, Chhatrapati Shahuji Maharaj Medical University), Lucknow, India.
Department of Urology, King George Medical University (also, Chhatrapati Shahuji Maharaj Medical University), Lucknow, India.
Urology. 2014 Aug;84(2):335-9. doi: 10.1016/j.urology.2014.04.038. Epub 2014 Jun 26.
To compare the results of transperitoneal laparoscopic vs retroperitoneoscopic simple nephrectomy for benign renal diseases in a prospective randomized design.
In this study between January 2009 and August 2013, 31 patients underwent transperitoneal laparoscopic nephrectomy and 31 retroperitoneoscopic nephrectomy after randomization. The 2 groups were compared for the visual pain score on the first and second postoperative days as the primary end point of the study. Complications were recorded and graded using Dindo-modified Clavien classification of surgical complications. Secondary objectives were to compare each of the operative techniques in terms of duration of surgery, complication rates, and postoperative convalescence. Statistical analysis was performed with SPSS version 16.0 with P <.05 considered statistically significant.
The difference in the visual pain score (4.9 vs 2.7 on day 1; 3.2 vs 1.1 on day 2) and the tramadol requirements (167.3 vs 132.8 mg) were statistically significant and more in the transperitoneal laparoscopic nephrectomy. The hospital stay and convalescence were significantly lower in retroperitoneoscopic group. Three patients in transperitoneal laparoscopic nephrectomy group and 2 patients in retroperitoneoscopic group required conversion. Mean time to normal activities was significantly less in retroperitoneal laparoscopic nephrectomy group (16.7 ± 3.5 vs 9.34 ± 4.9 days; P = .0001).
Although both transperitoneal laparoscopic and retroperitoneoscopic simple nephrectomy are feasible options for nonfunctioning kidneys due to benign renal diseases in adults, retroperitoneal laparoscopic nephrectomy is associated with significantly less pain, less analgesic requirement, shorter hospital stay, and short convalescence as compared with transperitoneal laparoscopic approach.
在一项前瞻性随机设计中，比较经腹腔腹腔镜与后腹腔镜单纯肾切除术治疗良性肾脏疾病的结果。
本研究于 2009 年 1 月至 2013 年 8 月期间，将 31 例患者随机分为经腹腔腹腔镜肾切除术组和后腹腔镜肾切除术组。将两组患者术后第 1 天和第 2 天的视觉疼痛评分作为研究的主要终点进行比较。记录并使用 Dindo 改良 Clavien 外科并发症分级系统对并发症进行分级。次要目标是比较两种手术技术在手术时间、并发症发生率和术后恢复期方面的差异。统计分析采用 SPSS 16.0 版，P<.05 为统计学差异有意义。
经腹腔腹腔镜肾切除术组的视觉疼痛评分（第 1 天 4.9 分，第 2 天 2.7 分；第 2 天 3.2 分，第 2 天 1.1 分）和曲马多需求量（167.3 毫克 vs 132.8 毫克）差异有统计学意义，且经腹腔腹腔镜肾切除术组更高。后腹腔镜肾切除术组的住院时间和恢复期明显较短。经腹腔腹腔镜肾切除术组 3 例和后腹腔镜肾切除术组 2 例需要中转开放手术。后腹腔镜肾切除术组患者恢复正常活动的平均时间明显较短（16.7±3.5 天 vs 9.34±4.9 天；P=.0001）。
虽然经腹腔腹腔镜和后腹腔镜单纯肾切除术对于成人良性肾脏疾病所致无功能肾脏都是可行的选择，但与经腹腔腹腔镜相比，后腹腔镜肾切除术术后疼痛较轻，镇痛需求较低，住院时间较短，恢复期较短。
