腹腔镜保留肾单位手术治疗复杂型肾癌的临床研究  

Clinical research of laparoscopic nephron sparing surgery in treatment of complex renal carcinoma

作　　者：王玉杰[1] 王文光[1] 闫燊燊 李晓东[1] 木拉提·热夏提[1] WANG Yujie;WANG Wenguang;YAN Shenshen;LI Xiaodong;Mulati Rexiati(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外科,乌鲁木齐830054

出　　处：《新疆医科大学学报》2020年第12期1546-1549,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：目的探讨腹腔镜保留肾单位手术在复杂型肾癌中应用的安全性及疗效。方法回顾性分析2014年8月-2020年8月就诊于新疆医科大学第一附属医院泌尿外科行腹腔镜保留肾单位手术的肾癌患者的临床资料,使用肾脏肿瘤测量评分系统(R.E.N.A.L.评分系统)评分代表肿瘤解剖及医师操作复杂程度。根据评分将患者分为3组:低评分组(4~6分),中评分组(7~9分),高评分组(10~12分),比较分析各组手术时间、术中出血量、术后并发症、切缘阳性率、患肾体积保留率及术后实际GFR下降<10%的比率指标差异,并分析低评分组与中、高评分组之间的术后复发及远处转移。结果104名患者全部顺利完成手术,其中低评分组41人(39.42%)、中评分组39人(37.50%)、高评分组24人(23.08%)。3组在患肾体积保留率[(0.88±0.12)、(0.84±0.11)、(0.77±0.14)]差异均有统计学意义(P<0.05),而在手术时间、术中出血量、术后并发症、切缘阳性率、局部复发或远处转移、术后实际肾小球滤过率(GFR)下降小于10%的比率差异均无统计学意义。结论腹腔镜保留肾单位手术在复杂性肾肿瘤的治疗安全可行,虽然在患肾体积保留率效果上不及简单肾癌,但能起到和简单肾癌一样的远期疗效和预后。Objective To investigate the safety and efficacy of laparoscopic nephron sparing surgery in the treatment of complex renal tumors.Methods The clinical data of renal cancer patients admitted to the Department of Urology of the hospital from August 2014 to August 2020 for laparoscopic nephrectomy were retrospectively analyzed.The application of R.E.N.A.L.nephrometry score represented the degree of tumor anatomy and the operation complexity of physicians.The patients were divided into three groups:low rating group(4-6 points),middle rating group(7-9 points)and high rating group(10-12 points).The operative time,intraoperative blood loss,postoperative complications,positive rate of surgical margin,postoperative pathological results,volume percentage of functional nephron retention,and the expected decrease rate of GFR were compared and analyzed.And postoperative recurrence and distant metastasis between the low-rating group and the middle-high rating group were analyzed.Results All the 104 patients in this study completed the operation successfully,including 41 patients in the low-rating group(39.42%),39 patients in the middle-rating group(37.5%),and 24 patients in the high-rating group(23.08%).Three groups in the risk of kidney volume retention rate had significant difference(P<0.05),while in operation time,intraoperative blood loss,postoperative complications,cut edge positive rate of local recurrence or distant metastasis,and postoperative GFR decline rate of less than 10%after operation showed no statistical difference between groups.Conclusion Laparoscopic Nephron sparing surgery is safe and feasible for the treatment of high-risk and complex renal tumors.Although it is not as effective as simple renal tumors in terms of volume retention rate,it has the same long-term efficacy and prognosis as simple renal tumors.

关 键 词：保留肾单位手术 复杂型肾癌 安全性 疗效 

分 类 号：R737[医药卫生—肿瘤]