Application of abdominal assisted orifice exhaust in retroperitoneoscopic radical nephrectomy for localized renal carcinoma

doi:10.3877/cma.j.issn.1674-3253.2020.06.006

Abstract

Abstract:

Objective

To evaluate the application value of abdominal assisted vent in retroperitoneoscopic radical nephrectomy for localized renal carcinoma.

Methods

A retrospective analysis was conducted on 193 patients with localized renal cancer in Affiliated Cancer Hospital of Zhengzhou University from January 1, 2016 to December 31, 2018. The patients were divided into the control group and the observation group according to different surgical routes. There were 97 cases in the observation group and 96 cases in the control group. The observation group underwent retroperitoneoscopic radical nephrectomy, and all patients underwent abdominal auxiliary hole exhaust, while the control group underwent laparoscopic radical nephrectomy. The operation time, intraoperative blood loss, surgical complications, postoperative hospital stay and blood gas analysis before pneumoperitoneum(T1), 60 min after pneumoperitoneum(T2) and 30 min after pneumoperitoneum stopped(T3) were respectively tested between the two groups.

Results

The operation time of the observation group was shorter than that of the control group, and the difference was statistically significant (P<0.05). There was no difference in intraoperative bleeding, operative complications and postoperative hospitalization time between the two groups, and no statistically significant difference in blood gas analysis level between the two groups or within each group (P>0.05).

Conclusion

Abdominal auxiliary hole exhaust can enlarge the field of retroperitoneal laparoscopic surgery, shorten the operation time, improve the surgical efficiency, so as to complete the operation more safely and effectively.

Key words: Pneumoperitoneum, Localized renal carcinoma, Laparoscopy, Radical nephrectomy, Blood gas analysis

Yimu Zhang, Jing Li, Pengcheng Zhao, Dong Yang, Pei Tian, Zhengyu Zhou, Junkai Ren, Chaohong He. Application of abdominal assisted orifice exhaust in retroperitoneoscopic radical nephrectomy for localized renal carcinoma[J]. Chinese Journal of Endourology(Electronic Edition), 2020, 14(06): 425-429.

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References 19

[1]	Clayman RV, Kavoussi LR, Soper NJ, et al. Laparoscopic nephrectomy: Initial case report[J]. J Urol, 1991, 146(2): 278-282.
[2]	Gaur DD. Laparoscopic operative retroperitoneoscopy: Use of a new device[J]. J Urol, 1992, 148(4): 1137-1139.
[3]	孔垂泽, 潘铁军, 孔祥波, 等. 肾癌诊断治疗指南[M]. 那彦群, 叶章群, 孙颖浩, 等. 中国泌尿外科疾病诊断治疗指南. 2014版. 北京: 人民卫生出版社, 2014: 3-4．
[4]	Roos FC, Steffens S, Junker K, et al. Survival advantage of partial over radical nephrectomy in patients presenting with localized renal cell carcinoma[J]. BMC Cancer, 2014, 14(1): 372.
[5]	李汉忠, 孙颖浩, 魏强, 等. 中国18家医院2008-2012年肾癌诊治现状分析[J]. 中华泌尿外科杂志, 2014, 35(6): 406-409.
[6]	Krabbe LM, Bagrodia A, Margulis V, et al. Surgical management of renal cell carcinoma[J]. Semin Intervent Radiol, 2014, 31(1): 27-32.
[7]	Jung JH, Kim HW, Oh CK, et al. Simultaneous robot-assisted laparoendoscopic single-site partial nephrectomy and standard radical prostatectomy[J]. Yonsei Med J, 2014, 55(2): 535-538.
[8]	Chang YH, Chang SW, Liu CY, et al. Demographic characteristics and complications of open and minimally invasive surgeries for renal cell carcinoma: a population-based case-control study in Taiwan[J]. Therapeutics and Clinical Risk Management 2018: 14 1235-1241．
[9]	MacLennan S, Imamura M, Lapitan MC, et al. Systematic review of oncological outcomes following surgical management of localised renal cancer[J]. Eur Urol, 2012, 61(5): 972-993.
[10]	Badalato GM, Kates M, Wisnivesky JP, et al. Survival after partial and radical nephrectomy for the treatment of stage T1bN0M0 renal cell carcinoma (RCC) in the USA: a propensity scoring approach[J]. BJU Int, 2012, 109(10): 1457-1462.
[11]	Alam R, Patel HD, Osumah T, et al. Comparative effectiveness of management options for patients with small renal masses: A prospective cohort study[J]. BJU Int, 2019, 123(1): 42-50.
[12]	Sprenkle PC, Power N, Ghoneim T, et al. Comparison of open and minimally invasive partial nephrectomy for renal tumors 4-7 centimeters[J]. Eur Urol, 2012, 61(3): 593-599.
[13]	Ljungberg B, Albiges L, Abu-Ghanem Y, et al. European association of urology guidelines on renal cell carcinoma: The 2019 update[J]. Eur Urol, 2019, 75(5): 799-810.
[14]	张旭, 朱庆国, 马鑫, 等. 后腹腔镜肾癌根治术的技术改进及临床效果(附30例报告)[J]. 临床泌尿外科杂志, 2002, 17(8): 402-404.
[15]	杨晓健, 王德娟, 胡成, 等．保持气腹压力的持续排气水封瓶装置在腹腔镜手术中的应用[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2019, 13(1): 5-9．
[16]	Fan X, Xu K, Lin T, et al. Comparison of transperitoneal and retroperitoneal laparoscopic nephrectomy for renal cell carcinoma:A systematic review and meta-analysis[J]. BJU Int, 2013, 111(4):611-621.
[17]	王臻帆, 魏海彬, 陈建春, 等. 腹腔镜和后腹腔镜切除术对肾上腺肿瘤患者的临床疗效、血气分析及血流动力学的影响[J]. 国际泌尿系统杂志, 2019, 39(1): 21-24．
[18]	高绍青, 吴颜娟, 余刚, 等. 腹腔镜与后腹腔镜CO₂气腹对患者血流动力学及C02排除量的影响[J]. 泸州医学院学报, 2012, 35(4): 407-409．
[19]	李鸣, 周利群, 李宁忱, 等. 后腹腔镜手术并发症原因分析[J/CD]. 中华泌尿外科杂志, 2007, 28(12): 810-812.

组别	例数	性别		年龄[岁，(±s)]	R.E.N.A.L评分(±s)	体质量指数[kg/m²，(±s)]
组别	例数	男	女	年龄[岁，(±s)]	R.E.N.A.L评分(±s)	体质量指数[kg/m²，(±s)]
观察组	97	57	40	59.3±3.6	8.0±1.6	22.3±1.2
对照组	96	64	32	60.2±3.5	8.2±1.8	22.5±1.3
统计值		χ²=1.289		t=1.761	t=0.816	t=1.111
P值		0.256		0.080	0.415	0.268

组别	例数	性别		年龄[岁，(±s)]	R.E.N.A.L评分(±s)	体质量指数[kg/m²，(±s)]
组别	例数	男	女	年龄[岁，(±s)]	R.E.N.A.L评分(±s)	体质量指数[kg/m²，(±s)]
观察组	97	57	40	59.3±3.6	8.0±1.6	22.3±1.2
对照组	96	64	32	60.2±3.5	8.2±1.8	22.5±1.3
统计值		χ²=1.289		t=1.761	t=0.816	t=1.111
P值		0.256		0.080	0.415	0.268

组别	例数	手术时间[min，(±s)]	术中出血[ml，(±s)]	并发症(例)	术后首次排气时间(h)	术后住院时间(d)
观察组	97	095±18	50±12	3	26.8±1.6	7.0±1.3
对照组	96	123±25	55±10	4	32.2±2.2	7.1±1.2
统计值		t=8.936	t=1.257	χ²=0.159	t=2.411	t=0.555
P值		<0.001	0.210	0.690	0.017	0.579

组别	例数	手术时间[min，(±s)]	术中出血[ml，(±s)]	并发症(例)	术后首次排气时间(h)	术后住院时间(d)
观察组	97	095±18	50±12	3	26.8±1.6	7.0±1.3
对照组	96	123±25	55±10	4	32.2±2.2	7.1±1.2
统计值		t=8.936	t=1.257	χ²=0.159	t=2.411	t=0.555
P值		<0.001	0.210	0.690	0.017	0.579

组别	例数	PaCO₂（mm Hg）			PaO₂（mm Hg）			pH值
组别	例数	T₁	T₂	T₃	T₁	T₂	T₃	T₁	T₂	T₃
观察组	97	36.3±4.0	45.2±4.3	37.0±4.2	440.4±8.1	452.4±9.3	443.5±7.2	7.40±0.04	7.32±0.13	7.36±0.16
对照组	96	36.6±4.2	44.4±4.9	37.0±4.1	439.5±8.2	451.4±9.4	445.1±7.5	7.41±0.05	7.33±0.12	7.35±0.17
t值		0.470	1.292	0	0.085	0.743	1.512	1.535	0.555	0.421
P值		0.639	0.198	1	0.932	0.458	0.132	0.126	0.579	0.674

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