Compared The Efficacy Of Laparoscopic And Open Partial Nephrectomy

Background and Purpose: Renal cell carcinoma is one of the most common malignant tumors of urinary system.As the development of abdominal imaging, the incidence of asymptomatic detected small renal masses has increased in the past20years. The morbidity of renal cell carcinoma currently covering about2%-3%of all the tumor disease. In2008, an estimated54,390new renal cancers were diagnosis in USA and there were approximately13,010deaths. The morbidity and the mortality rate increased year by year. According to the incidence of renal cell carcinoma in China,the number of the new patients is between20,000and47,000every year. In recent years its incidence rate is still arising. The national academic study of how to improve the treatment of renal cell carcinoma effectively has attract the world’s attention. Radical nephrectomy had been established as a golden standard of renal cell carcinoma. However, more studies reavealed that nephron-sparing surgery allows for maximal preservation of functioning nephrons with comparable oncologic outcomes. Laparoscopic partial nephrctomy emerged as a minimally invasive nephron-sparing surgical option for treating the appropriately selected renal mass.As we all know, laparoscopic partial nephrctomy has long learning curve and more operating times compared with open partial nephrectomy,so we have reason to compared the clinical effects with LPN and OPN,which contributes to study the feasibility of LPN,and how to control the bleeding of the surgical field,and how to decrease the time for renal vessel clamping.Methodsl.Casesandexelusioneriteriaineluded:(l)included standardsThe selective cases only include in renal tumors with Clinical stage T1NOM0. All these cases have received LPN or OPN.(2)The exclusion criteria(DDuring surgery at the same time,rule out these who under the surgery that co-operate with other clinic departments in order to avoid the interference of the statistical data ②Considering the complicated surgical manipulations, we ruled out those nephr-ons-paring surgical cases with deformation or anatomy variation,such as renal dupli-canon and horse shoe kidney.③Ruled out these patients who suffered with other disease that may impair the renal function.2.Case collectionBetween June2004to October2009, clinical data were respectively obtained on our49consecutive cases of LPN and20OPN. We gathered the detailed clinic data with these patients, including a detailed record of the name, gender, age, home address, telephone number, main complaint, tumor size, diagnosis, operative methods, date of surgery, amount of bleeding, the time of block of renal blood flow at usual temperature postoperative complications, the serum creatinine levels within three days after opertation, the hospitalization time after operation,B-ultrasound and CT urography or MRI results, etc.3. Results:All patients were operated successfully. The patient populations were demographically similar and the serum creatinine levels within three days post-opertation of all the cases were normal. Laparoscopic group and open group, operation time and intraoperative renal blood flow in blocked a long time, intraoperative complications, but the laparoscopic group, the mean blood loss was less in the open group. Laparoscopic group, one case of renal cell carcinoma and the door close proximity, in order to prevent intraoperative injury of renal part of the renal pedicle to open cut; two cases because of severe adhesion of inflammatory kidney tissue, kidney and tumor can not be fully free, to open renal part of the cut; laparoscopic group, the average length of stay10.5days, open group, the average hospital stay of14days. Open group and1patient had urinary leakage, delay microscope to bladder drainage of indwelling ureteral stents after the improvement of the treated groups All were cured and discharged, of which5patients had a transient mild increase of serum levels of muscle drunk, more than lOd returned to normal, does not appear oliguric acute renal failure and other manifestations. Case Report after renal margins were negative. Of postoperative complications in2 cases: one case of urinary fistula after surgery to maintain internal and external drainage (DJ tubes, wound drain) patency during the healing, postoperative wound drainage tube removed7days,1month DJ tube removed; one case of perirenal hematoma after surgery, absolute bed rest for2weeks after recovery. All patients were followed up for4to65months, the mean time of25months.3months after the first review, every six months to1year after a review. Review include renal function, isotope renography, X chest, B Super, CT and so on. Renal function were normal, no tumor recurrence4. Date analysisWe evaluated the role of the LPN in contrast to OPN by analyzing the data of the gender,age,tumor size, amount of bleeding,the time of block of renal blood flow at usual temperature, postoperative complications, the serum creatinine level within three days after opertation, the hospitalization time after operation etc. All the data were analyzed by SPSS16.0for Windows.We chose x2-test and independent t-test statistical methods depended on the different data information.5.Conclusions:Though with long learning curve and more post-operation complications,LPN is more challenging than OPN. LPN for the treatment of localized renal tumor has the advantages of minimal invasion and efficiency,and may be a goden standard for the small localized renal tumor. Further efforts need to be made to make this procedure less technically challenging and provide patient se-lection criteria to minimize surgical risk.