腹腔镜与开放肾部分切除术治疗复杂性肾癌的疗效比较  

Comparison of laparoscopic and open partial nephrectomy in treatment of complex renal cell carcinoma

作　　者：闫燊燊 王文光[1] 李晓东[1] 木拉提·热夏提[1] 王玉杰[1] YAN Shenshen;WANG Wenguang;LI Xiaodong;Mulati Rexiati;WANG Yujie(Department of Urology,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院泌尿中心,乌鲁木齐830054

出　　处：《新疆医科大学学报》2020年第12期1542-1545,共4页Journal of Xinjiang Medical University

基　　金：国家自然科学基金(81060210);新疆维吾尔自治区自然科学基金(2017D01C294)。

摘　　要：目的比较腹腔镜肾部分切除术(LPN)和开放式肾部分切除术(OPN)对复杂性肾癌(R.E.N.A.L.评分≥7)的疗效。方法分析2010年1月-2019年12月在新疆医科大学第一附属医院进行的OPN30例(OPN组)和LPN48例(LPN组)R.E.N.A.L.评分≥7肾癌患者的临床数据,并对两组患者的围手术期相关指标和疗效进行了比较。结果两组患者在性别、年龄、BMI、ASA分级、慢性病患病情况、术前肾小球滤过率(GFR)、R.E.N.A.L.评分分布等方面的差异均无统计学意义,同时两组在术中表现(如手术时间和估计失血量)以及保留有效肾单位方面(热缺血时间、患肾体积保留率及GFR相比术前下降率)差异无统计学意义。但LPN的患者住院天数更短(P=0.001),术中出血量更少(P=0.001);在肿瘤控制方面,两组在切缘阳性、复发情况和疾病特异性致死率上的差异无统计学意义(P>0.05)。结论对于R.E.N.A.L.评分≥7的肾癌患者,LPN由丰富经验的外科医师,在合理的手术规划设计下是安全可行的,LPN和OPN两种术式都能达到较好的肿瘤控制效果的同时,有效的保留了患侧肾功能。Objective To compare the efficacy of laparoscopic partial nephrectomy(LPN)and open partial nephrectomy(OPN)in the treatment of complex renal cell carcinoma(R.E.N.A.L.score≥7).Methods The clinical data of 30 patients with renal cell carcinoma whose R.E.N.A.L.score≥7 in the OPN group and 48 cases in the LPN group from the First Affiliated Hospital of Xinjiang Medical University during January 2010--December 2019 were analyzed,and the perioperative related indexes and curative effect of the two groups were compared.Results There were no significant differences in gender,age,BMI,ASA grade,chronic disease,preoperative GFR,R.E.N.A.L.score distribution between the two groups.Meanwhile,there were no significant differences in the intraoperative performance(operation time and estimated blood loss)and effective nephron retention(warm ischemia time,retention rate of affected renal volume and GFR decrease rate compared with preoperative)between the two groups.However,LPN patients had shorter hospital stay(P=0.001)and less intraoperative blood loss(P=0.001);in terms of tumor control,there was no significant difference in the positive margin,recurrence and disease-specific mortality between the two groups(P>0.05).Conclusion For renal cancer patients with R.E.N.A.L.score≥7,LPN is safe and feasible by experienced surgeons under reasonable surgical planning design.Both LPN and OPN can achieve better tumor control effect and effectively preserve the renal function of the affected side.

关 键 词：肾癌 肾部分切除术 腹腔镜 开放手术 

分 类 号：R737[医药卫生—肿瘤]