腹腔镜肾切除术作为门诊手术的应用

Laparoscopic Nephrectomy as Outpatient Surgery

Abstract
PURPOSE:
We tested the feasibility and safety of performing laparoscopic nephrectomy as outpatient surgery in patients with renal cancer.

MATERIALS AND METHODS:
We performed a prospective, multicenter, descriptive study between April 2014 and February 2015 with postoperative followup at 30 days. A total of 140 patients were diagnosed with renal cancer during this period, of whom 50 met study inclusion criteria and agreed to participate. Reasons for exclusion from analysis included planned partial nephrectomy in 35 patients, lived alone without adequate home support in 17, advanced age or significant comorbid conditions in 33 and refusal to participate in 5. Pain, nausea, fatigue, operative time, bleeding, postoperative care unit stay and hospital stay were assessed. Continuous variables were compared by the paired t-test and categorical variables were compared by the Fisher exact test.

RESULTS:
Mean age of the 35 males (70%) and 15 females (30%) treated with planned outpatient surgery was 59.8 years. Of the patients 46 (92%) were discharged home within the first 6 hours after surgery. Four patients (8%) could not be discharged due to wrong medication in 2, fatigue in 1 and intestinal injury in 1. None of the 46 patients discharged early were readmitted to the hospital. In 2 patients with wound infection oral antibiotic treatment achieved good results without rehospitalization.

CONCLUSIONS:
Laparoscopic nephrectomy may be performed as outpatient surgery in carefully selected patients who meet inclusion criteria, representing greater than 40% of candidates for the surgery. Our study demonstrates that outpatient nephrectomy may be done safely and does not require hospital readmission.

KEYWORDS:
feasibility studies; kidney neoplasms; laparoscopy; nephrectomy; outpatients

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