The Feasibility Analysis And Operative Experience Summary Of Laparoscopic Partial Nephrectomy

Objective: To analyze and compare the clinical indication and effect of laparoscopic partial nephrectomy and open partial nephrectomy,discuss the normalized standard and technique of laparoscopic partial nephrectomy,and introduce the doctor's comprehension about laparoscopic partial nephrectomy.Methods: Select 36 patients from the department of urinary surgery of the Second Hospital of Hebei Medical University,who have accepted the partial nephrectomy ,range from January,2005 to January,2011,including 11 cases of laparoscopic partial nephrectomy and 25 cases of open partial nephrectomy.All the cases were diagnosed through CT of kidney,and were confirmed through the pathological report.And then collect the age ,size of tumor,operative time, warm ischemia time,blood loss,recovery time,postoperative complications,hospital stay and follow-up inves- tigation.Then analyze the data.Results: There were no significance in the age,weight and tumor size of the two groups.Comparing the operative time,blood loss, hospital stay and warm ischemia time,the result is (OPN vs LPN:130.6±43.9min vs 174.1±55.7min;355.5±337.0ml vs 303.3±165.3ml;9.5±3.3d vs 9.4±3.2d;22.8±7.5min vs 33.1±12.1min).Only the difference in the operative time is significant(P<0.05).The 11 cases of LPN were done successfully,with no transference to OPN for postoperative bleeding;During the 25 cases of OPN, there was one cases which needed the second operation to hemostasis. One cases of LPN and two cases of OPN cut the pelvis to open,after saturation,there were no leakage of urine afteroperation; And two cases of LPN had a continuous infection and fever,which were cured after the use of better antibiotics; The cutting edge of all malignant tumor cases was negative in the postoperative pathological reports,with no relatpse after 5～68 months'follow up, and the kidney function of the two teams after operation is in the normal range.Conclusion: Laparoscopic partial nephrectomy is not only less traumatic , less scar ,but also less blood loss,postoperative discomforts and hospital stay. But to do an operation with the same difficulty,LPN will have a long operation time and warm ischemia time. For the patients with kidney neoplasms, laparoscopic partial nephrectomy is feasible,safe and effective.For the surgeon with proficient surgical technique,the size and site of the neoplasms is no longer the scruple,and the operative effect is elevating.Because of the operative complicacy and different viewpoint about the technical details,there is also much argument about LPN,LPN is still in a developing stage and become a important choice to treat kidney neoplasms.We believe in that,with more and more new laparoscopic equipments and materials be used,and the mature of the laparoscopic hemostasis skills ,suture and hypothymia protection technique ,the operation time and warm ischemia time of LPN will be mostly shortened,LPN will be the preference of the surgeons and patients in the future before long.