腹腔镜下肾动脉阻断肾部分切除术治疗cT1期肾癌的疗效及对肾功能的影响  

Efficacy of laparoscopic partial nephrectomy in the treatment of cT1 stage renal cell carcinoma and its effect on renal function

作　　者：陈家财 曾宾华 李金雨[1] 罗辉 林山 CHEN Jiacai;ZENG Binghua;LI Jinyu(Department of Urology,909th PLA Joint Service Support Force,Fujian,Zhangzhou 363000,China)

机构地区：[1]中国人民解放军联勤保障部队第909医院泌尿外科,福建漳州363000 [2]中国人民解放军联勤保障部队第909医院耳鼻喉颌面外科,福建漳州363000

出　　处：《临床外科杂志》2022年第2期121-124,共4页Journal of Clinical Surgery

摘　　要：目的 分析腹腔镜下肾动脉阻断肾部分切除术(LPN)治疗cT1期肾癌(RCC)的疗效及对病人肾功能的影响。方法 2014年1月~2019年1月收治的cT1期RCC病人108例,根据手术方法将其分为LPN组与腹腔镜根治性肾切除术(LRN)组,比较两组围术期相关指标、病人术后肾功能,并发症发生情况,随访2~24个月,统计两组病死率。结果 LPN组手术时间(120.65±20.36)分钟、术中出血量(124.65±19.47)ml,术后进食时间(1.59±0.36)天,LRN组分别为(86.63±17.85)分钟、(113.64±17.74)ml、(1.18±0.32)天,两组比较差异有统计学意义(P<0.05);LPN组引流管拔除时间(4.26±1.14)天、术后住院时间(8.71±2.27)天,LRN组分别为(4.03±1.02)天、(8.16±2.15)天,两组比较差异无统计学意义(P>0.05)。两组术后并发症发生率比较,差异无统计学意义(P>0.05)。术后,两组血肌酐(SCr)均较术前显著上升(P<0.05),肾小球滤过率(eGRF)水平较术前显著下降(P<0.05),而LPN组术后SCr低于LRN组(P<0.05),eGFR水平显著高于LRN组(P<0.05)。随访2~24个月,平均随访时间(15.41±3.36)个月,LPN组随访期间内有2例病人死亡,LRN组无死亡病例,两组病死率比较,差异无统计学意义(P>0.05)。结论 LPN与LRN手术在治疗cT1肾癌中的安全性相当,而采用LPN能有效保留具有功能的肾单位,降低术后慢性肾病及心血管疾病发生风险。但LPN依旧存在肿瘤切除不全风险,临床上应仔细评估肾癌病人机体条件与肿瘤状态,选择合适的术式。Objective To investigate the effect of laparoscopic partial nephrectomy with renal artery occlusion(LPN) in the treatment of cT1 stage renal carcinoma(RCC) and its effect on renal function.Methods 108 cT1 RCC patients admitted from January 2014 to January 2019 were divided into LPN group and LAPAROSCOPIC radical nephrectomy(LRN) group according to surgical methods.Perioperative related indicators, postoperative renal function and complications of the two groups were compared, and the mortality of the two groups was analyzed during 2-24 months follow-up.Results In LPN group, the operative time was(120.65±20.36) minutes, the intraoperative blood loss was(124.65±19.47) ml, and the postoperative feeding time was(1.59±0.36) days.LRN group were(86.63±17.85) min,(113.64±17.74) ml and(1.18±0.32) days, respectively, and the difference between the two groups was statistically significant(P<0.05).LPN group drainage tube removal time(4.26±1.14) days, postoperative hospital stay(8.71±2.27) days, LRN group(4.03±1.02) days,(8.16±2.15) days, there was no significant difference between the two groups(P>0.05).There was no significant difference in postoperative complication rate between the two groups(P>0.05).After surgery, serum creatinine(SCr) and glomerular filtration rate(eGRF) levels in both groups were significantly higher than those before surgery(P<0.05),while SCr and eGFR levels in LPN group were significantly lower than those in LRN group(P<0.05).The mean follow-up time was(15.41±3.36) months.During the follow-up period, 2 patients died in the LPN group and no death in the LRN group.There was no significant difference in mortality between the two groups(P>0.05).Conclusion LPN is as safe as LRN in the treatment of cT1 renal cancer, and LPN can effectively preserve functional nephron and reduce the risk of postoperative chronic kidney disease and cardiovascular disease.However, LPN still has the risk of incomplete tumor resection, so it is recommended to carefully evaluate the body conditions and tumor status of

关 键 词：腹腔镜下肾动脉阻断肾部分切除术 腹腔镜根治性肾切除术 cT1期肾癌 疗效 肾功能 

分 类 号：R737.11[医药卫生—肿瘤]