单孔腹腔镜与传统腹腔镜肾切除术治疗局限性肾癌的疗效比较:术后随访至少10年的配对研究  

Laparoendoscopic single-site nephrectomy compared with conventional laparoscopic nephrectomy for localized renal cancer:a matched-pair comparison with at least 10-year follow-up

作　　者：宋家璈 柳文强 陈童 吴小凤[1] 徐红[1] 吴震杰[1] 王林辉[1] SONG Jiaao;LIU Wenqiang;CHEN Tong;WU Xiaofeng;XU Hong;WU Zhenjie;WANG Linhui(Department of Urology,The First Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200433,China)

机构地区：[1]海军军医大学(第二军医大学)第一附属医院泌尿外科,上海200433

出　　处：《海军军医大学学报》2024年第7期844-850,共7页Academic Journal of Naval Medical University

基　　金：国家自然科学基金(82072825,81874093,82373253);上海市曙光计划(22SG35);上海市“医苑新星”人才培养计划(2020YYXX);上海市重中之重研究中心建设项目(2022ZZ01011).

摘　　要：目的比较单孔腹腔镜根治性肾切除术(LESS-RN)与传统腹腔镜根治性肾切除术(CL-RN)后至少10年的局限性肾癌患者肿瘤疗效和肾功能结局。方法选取2009-2012年在海军军医大学(第二军医大学)第一附属医院接受LESS-RN或CL-RN治疗的T1a~T2a期局限性肾癌患者,按患者年龄、BMI、肿瘤大小进行倾向评分匹配,共纳入31对患者,分析患者的基线特征、手术数据、病理结果和随访信息,以评估LESS-RN和CL-RN的长期预后差异。结果LESS-RN组与CL-RN组患者在手术时间[(179.7±43.0)min vs(172.6±50.9)min,P=0.349]、估计失血量[100(50,200)mL vs 100(50,150)mL,P=0.871]、住院时间[6(5,7)d vs 7(6,9)d,P=0.080]方面差异均无统计学意义。LESS-RN组有1例患者发生术中并发症,没有患者发生术后并发症;CL-RN组有1例患者发生术中并发症,3例患者发生术后并发症。LESS-RN组随访时间为(138.0±9.0)个月,CL-RN组为(137.8±9.8)个月(P=0.730)。LESS-RN组与CL-RN组患者总生存率(80.6%vs 74.2%,P=0.181)、肿瘤特异性生存率(93.6%vs 96.8%,P=0.554)、血肌酐变化水平[32(17,45)μmol/L vs 20(5,47)μmol/L,P=0.098]和估算的肾小球滤过率[(60.2±20.9)mL·min^(-1)·(1.73 m^(2))^(-1) vs(66.7±27.8)mL·min^(-1)·(1.73 m^(2))^(-1),P=0.342]差异均无统计学意义。结论LESS-RN是一种安全、可行的治疗局限性肾癌的手术方法,其长期肿瘤疗效和肾功能结局与CL-RN相当。Objective To compare the tumor and renal function outcomes of patients with localized renal cancer at least 10 years after laparoendoscopic single-site radical nephrectomy(LESS-RN)or conventional laparoscopic radical nephrectomy(CL-RN).Methods Totally 31 pairs of T1a-T2a localized renal cancer patients treated with LESS-RN or CLRN in The First Affiliated Hospital of Naval Medical University(Second Military Medical University)during 2009-2012 were matched by age,body mass index,and tumor size.Baseline characteristic,surgical data,pathological results,and followup information were analyzed to evaluate the long-term outcomes between the 2 groups.Results There were no significant differences between the LESS-RN and CL-RN groups in operative time([179.7±43.0]min vs[172.6±50.9]min,P=0.349),estimated blood loss(100[50,200]mL vs 100[50,150]mL,P=0.871),or hospital stay(6[5,7]d vs 7[6,9]d,P=0.080).Only 1 intraoperative complication occurred in both groups,while no postoperative complication occurred in the LESS-RN group and 3 in the CL-RN group.The follow-up time was(138.0±9.0)months in the LESS-RN group and(137.8±9.8)months in the CL-RN group(P=0.730).The overall survival rate(80.6%vs 74.2%,P=0.181),cancer-specific survival rate(93.6%vs 96.8%,P=0.554),change in creatinine level(32[17,45]μmol/L vs 20[5,47]μmol/L,P=0.098)or estimated glomerular filtration rate([60.2±20.9]mL·min^(-1)·(1.73 m^(2))^(-1) vs[66.7±27.8]mL·min^(-1)·(1.73 m^(2))^(-1),P=0.342)were not significantly different between the 2 groups.Conclusion LESS-RN is a safe and feasible surgical method for localized renal cancer with long-term tumor efficiency and renal function outcomes comparable to CL-RN.

关 键 词：肾肿瘤 肾细胞癌 单孔腹腔镜 腹腔镜肾切除术 根治性肾切除术 

分 类 号：R737.11[医药卫生—肿瘤]