肾肿瘤剜除与标准肾部分切除术对局限性肾癌术后正常肾实质保护的比较  

Comparison of renal parenchymal preservation between renal tumor enucleation and standard partial nephrectomy

作　　者：董文[1] 欧德华 高明[2] 王晨阳 廖蓓[3] 陈旭[1] 钟文龙 刘皓[1] 谢伟槟[1] 吴少旭[1] 林天歆[1] 黄健[1] DONG Wen;OU Dehua;GAO Ming;WANG Chenyang;LIAO Bei;CHEN Xu;ZHONG Wenlong;LIU Hao;XIE Weibing;WU Shaoxu;LIN Tianxin;HUANG Jian(Department of Urology,Sun Yat-sen Memorial Hospital,Sun Yat-sen Umvermty,Guangzhou,510288,China;Department of Radiology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University;Department of Neurology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University)

机构地区：[1]中山大学孙逸仙纪念医院泌尿外科,广州510288 [2]中山大学孙逸仙纪念医院放射科 [3]中山大学孙逸仙纪念医院神经内科

出　　处：《临床泌尿外科杂志》2019年第1期9-13,共5页Journal of Clinical Urology

摘　　要：目的:比较肾肿瘤剜除(TE)与标准肾部分切除术(SPN)对局限性肾癌术后患侧正常肾实质保护的差异,为临床合理选择肿瘤剜除提供依据。方法:回顾性分析2015～2016年我院肾部分切除术患者资料,纳入手术前及术后3～12个月均行增强CT及肾功生化且确诊为单侧单发性肾肿瘤患者。观察SPN组与TE组热缺血时间、手术切缘、术后病理、并发症及术后肾功能等,比较2种手术方式对保留患侧肾脏正常肾实质的差异。多元线性回归分析肾部分切除术后正常肾实质丢失的相关因素。结果:所有手术均经腹腔镜顺利完成,无中转开放手术病例。SPN组与TE组热缺血时间比较差异有统计学意义(23.5min vs.21.0min,P=0.042),术中出血量、切缘阳性率、病理分期分级以及术后并发症发生率差异均无统计学意义。术后3～12个月复查CT未见肿瘤残留及复发病例。术后SPN组与TE组肾体积丢失差异有统计学意义(19.9cm^3 vs.10.26cm3,P=0.017)。多因素分析发现肿瘤直径与手术方式和肾部分切除术后患侧正常肾实质丢失明显相关。结论:肾肿瘤剜除是一种技术上可行、肿瘤学上安全的一种保留肾单位手术。肾TE较SPN能保留更多的正常肾实质,是临床保留肾单位手术的合理选择。Objective:To compare the difference of renal parenchymal preservation between renal tumor enucleation(TE)and standard partial nephrectomy(SPN).Method:A retrospective analysis of patients with partial nephrectomy in Sun Yat-sen Memorial Hospital from 2015 to 2016 was performed.Patients who underwent preoperative and postoperative enhanced CT and renal biochemistry and were diagnosed with unilateral single renal tumor were enrolled.Operative time,warm ischemia time,blood loss,surgical margin,complications,pathological outcomes and preservation of renal parenchyma in the ipsilateral kidney were compared between TE and SPN.Multiple linear regression analysis was used to identify the factors associated with renal parenchymal loss after partial nephrectomy.Result:All operations were successfully performed by laparoscopy,and none was transferred to open surgery.No statistical difference existed between the two groups in operative time,blood loss,positive surgical margin,complication,pathological outcomes except for warm ischemia time(SPN vs.TE,23.5 min vs.21 min,P=0.042).There was no recurrence happened in 3-12 months after surgery by CT scan.Parenchymal loss was 19.9 cm3 and 10.26 cm3 for SPN and TE,respectively(P=0.017).Multivariate analysis revealed that tumor diameter and surgical approach were significantly associated with renal parenchymal loss after partial nephrectomy.Conclusion:Renal TE is a technically feasible,oncologically safe methods of nephron-sparing surgery.Renal TE can preserve more normal renal parenchyma than SPN,which is a reasonable choice for nephron-sparing surgery.

关 键 词：肿瘤剜除术 标准肾部分切除术 腹腔镜 肾实质保护 

分 类 号：R737.11[医药卫生—肿瘤]