两种保留肾单位术式治疗T1α期肾癌的临床疗效比较  

Clinical Efficacy of Two Kinds of Nephron-Sparing Surgeries in the Treatment of Stage T1 Renal Carcinoma

作　　者：顾硕[1] 徐宗源[1] 

机构地区：[1]南京医科大学附属淮安第一医院泌尿外科,江苏南京223000

出　　处：《医学临床研究》2017年第8期1518-1520,共3页Journal of Clinical Research

摘　　要：【目的】比较腹腔镜保留肾单位手术（NSS）与开腹NSS治疗T1α期肾癌的临床疗效。【方法】回顾性分析2014年1月至2015年12月本院收治的74例T1α期肾癌患者的临床资料，根据手术方法将其分为腹腔镜组（n=40）和开腹组（n=34），比较两组手术及术后恢复情况、并发症发生率、切缘阳性率，并测定血浆肌酐（SCr）水平，计算双肾总肾小球滤过率（GRF），门诊或电话随访术后随访7～28个月，记录两组复发转移情况。【结果】两组术后引流时间、切缘阳性率比较差异无统计学意义（P〉0．05），腹腔镜组手术时间、肾缺血时间长于开腹组，术中出血量、住院时间短于开腹组，差异有统计学意义（P〈0．05）。两组患者手术前后血浆SCr水平比较，差异无统计学意义（P〉0．05），术后GFR水平低于术前，差异具有统计学意义（P〈0．05）；两组患者术前、术后血浆SCr、GFR水平比较，差异无统计学意义（均P〉0．05）。腹腔镜组术后并发症发生率为10．0％（4／40）低于开腹组的29．41％（10／34），差异有统计学意义（x2=4．515，P=0．034〈0．05）。两组影像学检查证实无1例复发、转移，其中腹腔镜组一例病死于心脑血管疾病。【结论】腹腔镜NSS术与开腹NSS术的肿瘤控制效果相似，但腹腔镜NSS术可缩短术后恢复时间、降低并发症发生率，肾缺血时间虽有所延长但尚未加重肾功能损伤。[Objective]To investigate the clinical efficacy of two kinds of nephron-sparing surgeries in the treatment of stage T1 renal carcinoma. [Methods]The clinical data of 74 patients with stage Tla renal carcinoma treated by nephron-sparing surgery （NSS） in our hospital from January 2014 to December 2015 were retrospectively analyzed. According to the surgical method, the patients were divided into the laparoscopic group （40 cases） and laparotomy group （34 cases）. The state of surgery and postoperative recovery, the incidence of complications and the positive rate of resection margin were compared between the two groups. The serum creatinine （SCr） level was determined, and the total glomerular filtration rates （GRF） of double kidneys were calculated. All patients were followed up for 7- 28 months. The state of recurrence and metastasis in the two groups was recorded. [Results1 There was no significant difference between the two groups in postoperative drainage time and the positive rate of resection margin （ P 〉0.05）. The surgical time and renal ischemia time of the laparoscopic group were longer than those of the laparotomy group, while the intraoperative blood loss and length of hospital stay were less and shorter than those of the laparotomy control group （ P 〈0.05）. After surgery, GFR levels decreased in the two groups （ P〈0.05）, but there was no significant difference between the two groups （ P 〉0.05）. The incidence of postop- erative complications was lower in the laparoscopic group than in the laparotomy group （10.0% vs 29.41% ） （X2 = 4.515, P〈0.05）. There was no recurrence or metastasis in the two groups. [Conclusion] The tumor control effect of laparoscopic NSS and open NSS is similar. However, laparoscopic NSS can shorten the postoperative recovery time and reduce the incidence of postoperative complications. Though the time of renal ischemia is prolonged, renal damage is not aggravated.

关 键 词：肾肿瘤/外科学 肿瘤分期 腹腔镜检查 肾单位 

分 类 号：R737.11[医药卫生—肿瘤]