【Abstract】 Objective To compare the clinical effect of three different nephron-sparing surgical methods including peritoneal laparoscopy, retroperitoneal laparoscopy and open surgery for localized renal carcinoma. Methods The clinical data of 99 patients with localized renal carcinoma from March 2008 to March 2015 were retrospectively analyzed. According to the methods of operation,they were divided into three groups,group A (35 patients, underwent peritoneal laparoscopic excision) , group B (30 patients, underwent retroperitoneal laparoscopic excision) and group C (32 patients, underwent open surgery). The operating time, renal warm ischemia time, blood loss, hospital stay, postoperative recurrence and metastasis were compared among the three groups and were statistically analyzed. Results 1 cases in the abdominal group and the retroperitoneum group were transferred to open surgery because of extensive adhesion around the tumor, except for this study, and 97 cases were eventually included. The operation time of group A, group B and group C were (145.3+32.4)min and (126.4土33.1)min and (114+ 31.3)min, respectively. There was no significant difference in operative time between the abdominal laparoscopy group and the laparoscopic group. The operative time in the two groups was higher than that in the open operation group (P<0.05). The bleeding volume in group A, group B and group C were (111.3±36.2) ml, (124土 52.7) ml and( 192.6 土 78.1) ml, respectively, and the difference between the three groups was statistically significant (P<0.05). The number of blood transfusion in group A, group B and group C were 8 cases, 6 cases and 10 cases, respectively. There was no significant difference between the three groups (P<0.05). The indwelling time of abdominal drainage tube of group A, group B and group C were (7.1+3.2)d,(5.4土2.4)d and(5.3土1.6)d, respectively, and there was no significant difference between the three groups (P<0.05). The hospitalization time of were were (11.6+4.3) d, (10.1+3.6)d and (13.8±3.2) d, respectively. The time of hospitali-zation in the abdominal laparoscopy group and the retroperitoneoscope group was significantly lower than that in the open operation group, with statistical significance(P<0.05). There was no significant difference in renal function indexes GFR, BUN and Scr between the three groups before and after operation(P〉0.05). There was a significant difference between the R. E. N. A. L score and the average operation time, blood loss and renal ischemia time（P<0.05) , but no correlation with creatinine changes(p〉0.05). The postoperative complications were classified by Clavien system, 16 cases were I grade (including postoperative fever, pain, vomiting, 10 cases in the open group, 3 cases in the abdominal group and the retroperitoneal group) , 7 cases were 11( including the addition of antibiotics , blood transfusion , 3 cases in the opengroup 2casesin=heabdominalgroupand=here=roperioneumgroup)in2cases(=hedoubleJ=ubewasplacedunder the leak urine endoscope after the operation. All of them were endoscopy , 1 case in the abdominal group and the retroperitoneal group. The pathological results were 82 cases of clear cell carcinoma , 1 cases of multi chamber cystic renal carcinoma 11AasesofpapilaryAelAarAinomaand3AasesofAhromophobeAelAarAinoma.TheinAision marginwasnegative after operation. No recurrence or metastasis was observed after three years follow-up. Conclusion In the treatment of selective clinical T2 stage renal carcinoma , the different kidney preservation methods can achieve better control effect and protect the renal function. The R. E. N. A. L score is an important index for evaluating the feasibility of renal unit opera- tioninT2stagerenalcelcarcinoma.