| Objective: comparing clinical effects of nephron-sparing surgery with retroperitoneoscopy and that of open surgery in the treatment of kidney neoplasms, this research aims to evaluate the feasibility and treatment outcome.Methods: retrospective analysis on 80 kidney neoplasms subjects, recorded by Department of Urology, Qinghai University Affiliated Hospital from September 2011 to December 2015, including 25 subjects of nephron-sparing surgery with retroperitoneoscopy and 55 subjects of open surgery, was conducted in this research.80 subjects were divided into two groups, retroperitoneoscopy surgery group and open surgery group. Clinical data of these two groups was respectively recorded and compared in many aspects, such as, operation time, time of kidney ischemia during operation, blood loss during operation, postoperative hospital stay, average time of postoperative intestinal function recovery, operative complications, creatinine levels before operation and 3 months after operation. In addition, postoperative visit was made to the two groups with duration varying from 3 months to 36 months, and any postoperative neoplasm recurrence or metastasis was recorded.Results:80 kidney neoplasms subjects, among which 25 are subjects of nephron-sparing surgery with retroperitoneoscopy and 55 are subjects of open surgery, are studied in this research. There is no significant difference in the age, gender, size of neoplasm, diameter of neoplasm, ASA scores, position of kidney, location of neoplasm, TNM classification and creatinine level before operation of the two groups(P>0.05). When comparing postoperative pathology of the two groups: 6 benign tumors(24.00%) and 19 malignant tumors(76.00%) in retroperitoneoscopy surgery group and 13 benign tumors(23.63%), 42 malignant tumors(76.37%) in open surgery group, no significant difference between these two groups can be claimed as pvalue is higher than 0.05. Average time of operation in retroperitoneoscopy surgery group is(128.60±13.54) mins while that of the open surgery group is(127.84±10.36) mins, and there is no significant difference between the two groups in this aspect(P>0.05). As for average creatinine levels of the subjects when they are reviewed 3 months after operation, the number of retroperitoneoscopy surgery group is(76.00±8.17)umol/L and that of the open surgery group is(75.44±7.46) umol/L. There is no significant difference between the two groups in this aspect in that the P value is larger than 0.05. Average time of renal ischemia for retroperitoneoscopy surgery group is(29.48±2.43) mins, which is significantly longer than that of the open surgery group(19.98±2.73)mins, and this difference is significant as the P value is smaller than 0.05. Regarding average blood loss during operation, the average blood loss for retroperitoneoscopy surgery group is(200.92±20.51) ml, significantly different from that of the open group(361.18±29.38) ml(P<0.05). Average time of postoperative intestinal function recovery and postoperative hospital stay for open surgery group are(2.01±1.28)d and(10.47±1.45)d respectively, significantly longer than that of the retroperitoneoscopy surgery group,(1.00±0.82)d and(8.00±1.23)drespectively(P<0.05). Among 25 retroperitoneoscopy surgeries, there are 1 surgery with pleural injury and 1 surgery with peritoneal injury. And among 55 open surgeries, there are 4 surgeries with massive hemorrhage, 3 surgeries with pleural injury, 4 surgeries with peritoneal injury and 6 surgeries with postoperative wound infections. Thus, in terms of operative complications, the rate of retroperitoneoscopy surgery group is 8.00%, significantly smaller than that of the open surgery group 30.90%(P<0.05). Regarding 61 subjects with malignant tumors, among which 19(76.00%) belong to retroperitoneoscopy surgery group and 42(76.37%) are included in the open surgery group, postoperative visits are made for them, with duration varying from 3 months to 36 months. Results of the visits show that all subjects are alive and no neoplasm recurrence or metastasis occurs in the two groups. Conclusions:compared with open nephron-sparing surgery, the advantages of nephron-sparing surgery with retroperitoneoscopy are of high security, less trauma to patients, speedy recovery and so on and so forth. In terms of operation time, there is no significant difference between the two groups. Regarding blood loss during operation and the rate of operative complications, open surgery group is larger and higher than retroperitoneoscopy surgery group. In addition, open surgery group is longer than retroperitoneoscopy surgery group in respects of time of postoperative intestinal function recovery and postoperative hospital stay. Even though retroperitoneoscopy surgeries have longer time of kidney ischemia than open surgeries, no significant difference can be found by examining creatinine levels of the two group subjects when they are reviewed 3 months after operation. No neoplasm local recurrence or distant metastasis has been found in the two groups through imaging review. |
