腹腔镜肾部分切除术与开放性肾部分切除术治疗复杂性肾肿瘤的疗效对比
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摘要
目的探讨后腹腔镜肾部分切除术(RLPN)与开放性肾部分切除术(OPN)治疗复杂性肾肿瘤的临床效果。方法我院152例复杂性肾肿瘤患者,行RLPN者纳入观察组(n=95),行OPN者纳入对照组(n=57)。比较术后2周、3个月时,两组肾功能指标、血清炎症因子变化,围术期基本情况及术后2周内并发症发生率。结果术后2周时,两组血肌酐(SCr)、胱抑素C(Cys-C)水平均较治疗前提升,且观察组高于对照组;两组肾小球滤过率(e GFR)水平较治疗前下降,且观察组低于对照组;两组肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素-6(IL-6)水平均较术前提升,且观察组低于对照组(P <0. 05)。术后3个月时,两组SCr、Cys-C、TNF-α、CRP、IL-6水平均较治疗前提升,e GFR水平较治疗前下降(P <0. 05),组间比较差异均无统计学意义(P> 0. 05)。观察组阻断时间、手术时间均高于对照组,术中失血量、术后引流时间、术后肛门排气时间、术后住院时间均少于对照组(P <0. 05)。术后2周内,观察组并发症发生率低于对照组(P <0. 05)。结论 RLPN与OPN治疗复杂性肾肿瘤近期疗效均属良好,但前者安全性更为理想,有利于促进患者预后康复。
Objective To investigate the clinical effects of retroperitoneal laparoscopic partial nephrectomy( RLPN) and open partial nephrectomy( OPN) for complex renal tumors. Methods The clinical data of 152 patients with complex renal tumors in our hospital were retrospectively analyzed.Patients with RLPN were included in observation group( n = 95),and patients with OPN were included in control group( n = 57). The changes of renal function indexes and serum inflammatory factors before operation and at 2weeks and 3 months after operation,and the basic perioperative conditions and the concurrence of complications within 2 weeks after operation were compared between the two groups.Results At 2 weeks after operation,the levels of serum creatinine( SCr) and cystatin C( Cys-C) in the two groups were significantly higher than those before operation,and the levels in observation group were significantly higher than those in control group( all P < 0. 05). The estimated glomerular filtration rate( e GFR) level after operation in the two groups was significantly lower than that before operation,and the level in the observation group was significantly lower than that in the control group( all P < 0. 05).The levels of tumor necrosis factor-α( TNF-α),C-reactive protein( CRP) and interleukin-6( IL-6) after operation in the two groups were significantly higher than those before operation,and the levels in observation group were significantly lower than those in the control group at the same time( all P < 0. 05).After 3 months of operation,the levels of SCr,Cys-C,TNF-α,CRP and IL-6 in the two groups were significantly higher than those before operation while the e GFR level was significantly lower than that before operation( all P < 0. 05).However,there was no statistical difference between the groups( all P > 0. 05).The blocking time and operative time in the observation group were significantly longer than those in the control group,but intraoperative blood loss,postoperative drainage time,postoperative anus exhaust time and postoperative hospital stay were significantly less than those in the control group( all P < 0. 05).Within 2 weeks after operation,the incidence rate of complications in the observation group was significantly lower than that in the control group( P < 0. 05).Conclusion Both RLPN and OPN have good short-term efficacy in treatment of complex renal tumors,but the former has more ideal safety and is conducive to the prognosis of the patients.
Objective To investigate the clinical effects of retroperitoneal laparoscopic partial nephrectomy( RLPN) and open partial nephrectomy( OPN) for complex renal tumors. Methods The clinical data of 152 patients with complex renal tumors in our hospital were retrospectively analyzed.Patients with RLPN were included in observation group( n = 95),and patients with OPN were included in control group( n = 57). The changes of renal function indexes and serum inflammatory factors before operation and at 2weeks and 3 months after operation,and the basic perioperative conditions and the concurrence of complications within 2 weeks after operation were compared between the two groups.Results At 2 weeks after operation,the levels of serum creatinine( SCr) and cystatin C( Cys-C) in the two groups were significantly higher than those before operation,and the levels in observation group were significantly higher than those in control group( all P < 0. 05). The estimated glomerular filtration rate( e GFR) level after operation in the two groups was significantly lower than that before operation,and the level in the observation group was significantly lower than that in the control group( all P < 0. 05).The levels of tumor necrosis factor-α( TNF-α),C-reactive protein( CRP) and interleukin-6( IL-6) after operation in the two groups were significantly higher than those before operation,and the levels in observation group were significantly lower than those in the control group at the same time( all P < 0. 05).After 3 months of operation,the levels of SCr,Cys-C,TNF-α,CRP and IL-6 in the two groups were significantly higher than those before operation while the e GFR level was significantly lower than that before operation( all P < 0. 05).However,there was no statistical difference between the groups( all P > 0. 05).The blocking time and operative time in the observation group were significantly longer than those in the control group,but intraoperative blood loss,postoperative drainage time,postoperative anus exhaust time and postoperative hospital stay were significantly less than those in the control group( all P < 0. 05).Within 2 weeks after operation,the incidence rate of complications in the observation group was significantly lower than that in the control group( P < 0. 05).Conclusion Both RLPN and OPN have good short-term efficacy in treatment of complex renal tumors,but the former has more ideal safety and is conducive to the prognosis of the patients.
引文
[1]张树栋,马潞林.EAU 2016肾肿瘤研究进展[J].中华泌尿外科杂志,2016,37(6):401-402.
[2]王莹,李真,宋鑫.转移性肾癌靶向治疗研究新进展[J].实用肿瘤杂志,2013,28(6):569-574.
[3]王林辉,徐逸凡,刘冰,等.五类微创技术在局限性肾肿瘤保留肾单位手术中的临床应用特点和效果[J].上海医学,2015,38(7):573-578.
[4]刘亮,赵晓风.后腹腔镜肾部分切除术与开放手术治疗肾肿瘤的手术疗效比较[J].中国临床医生杂志,2016,44(3):68-70.
[5]赵明,李昌水,滕晓东.介绍国际泌尿病理协会2012肾肿瘤的专家共识[J].中华病理学杂志,2014,43(3):207-211.
[6]苏超,张桂霞,王瑞峰,等.CKD-EPI方程估算中国慢性肾脏病患者肾小球滤过率的适用性评价[J].中华疾病控制杂志,2013,17(7):621-624.
[7]王强,张旭.肾部分切除术治疗复杂性肾肿瘤的研究现状及进展[J].微创泌尿外科杂志,2016,5(5):314-320.
[8]王云鹏,陈光富,张旭,等.影响腹腔镜保留肾单位手术术后肾功能恢复的因素分析[J].微创泌尿外科杂志,2015,4(6):380-384.
[9]方群鹰.低温保护技术在腹腔镜肾部分切除术中的应用进展[J].中国微创外科杂志,2013,13(5):461-463.
[10]吴雄辉,余祖虎,来永庆,等.后腹腔镜肾部分切除术学习曲线的研究[J].临床泌尿外科杂志,2015,30(5):389-392.
[11]魏勇,蔡海,许宁,等.CTA技术在腹腔镜选择性肾段动脉阻断肾部分切除术中的应用[J].临床放射学杂志,2014,33(12):1891-1894.
[12]黄吉炜,孔文,陈勇辉,等.开放性肾部分切除术后出血的危险因素分析及临床处理[J].中华泌尿外科杂志,2013,34(9):649-652.
[13]王峰.内镜黏膜下剥离术在早期大肠癌及癌前病变的临床研究[J].成都医学院学报,2017,12(1):73-76.
[14]杨渝,邵志强,郭嘉祥.腹腔镜下行保留肾单位的肾肿瘤切除术对患者氧化应激反应以及红细胞糖代谢的影响[J].国际泌尿系统杂志,2016,36(1):52-54.
[15]王栋,纪志刚,李汉忠.术前选择性动脉栓塞联合腹腔镜肿瘤剜除术在肾错构瘤中的应用[J].中国微创外科杂志,2016,16(2):101-105.
[2]王莹,李真,宋鑫.转移性肾癌靶向治疗研究新进展[J].实用肿瘤杂志,2013,28(6):569-574.
[3]王林辉,徐逸凡,刘冰,等.五类微创技术在局限性肾肿瘤保留肾单位手术中的临床应用特点和效果[J].上海医学,2015,38(7):573-578.
[4]刘亮,赵晓风.后腹腔镜肾部分切除术与开放手术治疗肾肿瘤的手术疗效比较[J].中国临床医生杂志,2016,44(3):68-70.
[5]赵明,李昌水,滕晓东.介绍国际泌尿病理协会2012肾肿瘤的专家共识[J].中华病理学杂志,2014,43(3):207-211.
[6]苏超,张桂霞,王瑞峰,等.CKD-EPI方程估算中国慢性肾脏病患者肾小球滤过率的适用性评价[J].中华疾病控制杂志,2013,17(7):621-624.
[7]王强,张旭.肾部分切除术治疗复杂性肾肿瘤的研究现状及进展[J].微创泌尿外科杂志,2016,5(5):314-320.
[8]王云鹏,陈光富,张旭,等.影响腹腔镜保留肾单位手术术后肾功能恢复的因素分析[J].微创泌尿外科杂志,2015,4(6):380-384.
[9]方群鹰.低温保护技术在腹腔镜肾部分切除术中的应用进展[J].中国微创外科杂志,2013,13(5):461-463.
[10]吴雄辉,余祖虎,来永庆,等.后腹腔镜肾部分切除术学习曲线的研究[J].临床泌尿外科杂志,2015,30(5):389-392.
[11]魏勇,蔡海,许宁,等.CTA技术在腹腔镜选择性肾段动脉阻断肾部分切除术中的应用[J].临床放射学杂志,2014,33(12):1891-1894.
[12]黄吉炜,孔文,陈勇辉,等.开放性肾部分切除术后出血的危险因素分析及临床处理[J].中华泌尿外科杂志,2013,34(9):649-652.
[13]王峰.内镜黏膜下剥离术在早期大肠癌及癌前病变的临床研究[J].成都医学院学报,2017,12(1):73-76.
[14]杨渝,邵志强,郭嘉祥.腹腔镜下行保留肾单位的肾肿瘤切除术对患者氧化应激反应以及红细胞糖代谢的影响[J].国际泌尿系统杂志,2016,36(1):52-54.
[15]王栋,纪志刚,李汉忠.术前选择性动脉栓塞联合腹腔镜肿瘤剜除术在肾错构瘤中的应用[J].中国微创外科杂志,2016,16(2):101-105.