后腹腔镜根治性肾切除术与保留肾单位的肾部分切除术治疗肾癌的疗效比较  

Comparative study on clinical effects between retroperitoneal laparoscopic radical nephrectomy and nephron-sparing surgery for renal cell carcinoma

作　　者：李斌 李睿舒 邓旺生 易琨 

机构地区：[1]荆州市中医医院泌尿外科,湖北荆州434000

出　　处：《临床泌尿外科杂志》2015年第1期14-17,共4页Journal of Clinical Urology

摘　　要：目的：评价后腹腔镜根治性肾切除术（RN）与保留肾单位的肾部分切除术（NSS）治疗肾癌患者的远期疗效评价。方法：选取我院2008年1月～2013年5月期间收治的行后腹腔镜手术的肾癌患者186例，按手术方式不同分为RN组（98例）和NSS组（88例），对两组患者各项临床指标进行均衡性检验，对比两组手术时间、术中出血量、中转开放例数、术后禁食时间、术后住院时间及术后并发症，并对随访结果进行生存分析，比较两组5年总生存率（OS）及无复发生存率（RFS）。结果：两组患者年龄、性别、体质指数（BMI）、腹部手术史及肿瘤直径、部位、分侧差异无统计学意义（P〉0．05），RN组与NSS组手术时间（108．9±36．7）minVS（116．2±13．4）min，P=0．08、术中出血量（63．1±21．5）ml VS（71．9±52．8）ml，P=0．13、中转开放例数（／98VS2／88，P=0．60）、引流管留置时间（2．3±1．2）dVS（2．5±1．6）d，P=0．33及术后并发症（1／98VS1／88，P=1．00）差异无统计学意义；而NSS组与RN组相比，术后禁食时间短（1．5±1．2）dVS（2．7±2．0）d，P〈0．01，术后下床时间早（2．3±1．9）dVS（3．4±2．1）d，P〈0．051，住院时间短（4．8±1．5）dVS（5．9±2．8）d，P=0．001。生存分析显示RN组患者5年OS为96．2％，RFS为93．4％；NSS组5年OS为95．4％，RFS为92．1％，两组间各生存率差异无统计学意义（P〉0．05）。结论：NSS治疗T。b期及以前的肾癌短期疗效好于RN，长期疗效两者效果相近，有条件的医院可酌情推广。Objective： To compare the long-term results between retroperitoneal laparoscopic radical nephrectomy （RN） and nephron-sparing surgery （NSS） for renal cell carcinoma. Method： We retrospectively collected 186 renal cell carcinoma patients who received retroperitoneal laparoscopic RN or NSS at our department during the period of 2008-2013. According to the method of operation, patients were divided them into RN group （98 cases） and NSS group （88 cases）. Statistical methods were used on the terms of patients gender, age, BMI, abdominal surgery histories etc. Statistical comparative methods were used on the terms of operative time, blood loss, num- ber of conversion to open surgery, time of first oral intake, postoperative hospital stay and number of complica- tions. Kaplan-Meier method was used to calculate the follow-up data. Five-year overall survival （OS） and recur- rence-free survival （RFS） were conducted by survival curve, and long-rank tests were conducted to evaluate the differences between two groups. Result： There were no significant difference on the terms of age, gender, BMI, abdominal surgery history, tumor diameter, tumor position, tumor side, operation time （108.9± 36.7） min vs （116.2±13.4） min, P =0.08, blood loss （63.1±21. 5） ml vs （71.9±52.8） ml, P =0.13, number of con- version to open surgery （1/98 vs 2/88, P =0.60）, drainage tube time （2.3±1.2） d vs （2.5±1.6） d, P = 0.33 and postoperative complications （1/98 vs 1/88, P = 1.00） between two groups （ P 〉0.05）. Compared with RN group, NSS owned earlier time of first oral intake （1.5±1.2） d vs （2.7±2.0） d, P d0.01, shorter ambulation time （2.3±1.9） d vs （3.4±2.1） d, P d0.05 and shorter postoperative hospital stay （4.8±1.5） d vs （5.9±2.8） d, P =0. 001. Survival analyses showed the 5-year OS and RFS of RN were 96.2% and 93.4% respectively. Five-year OS and RFS of NSS group were 95.4% and 92.1% respectively. Log-rank tests showed that there were no sign

关 键 词：肾癌 后腹腔镜 保留肾单位手术 微创 

分 类 号：R737.11[医药卫生—肿瘤]