腹腔镜下保留肾单位手术治疗老年局限性肾癌疗效观察
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摘要
目的探讨腹腔镜下保留肾单位手术治疗老年局限性肾癌疗效。方法将2011年1月至2013年1月扬州大学附属医院和南京市第二医院收治的64例老年局限性肾癌患者分为观察组和对照组,每组32例。观察组患者给予腹腔镜下保留肾单位手术治疗,对照组患者给予开放保留肾单位手术治疗。比较2组患者手术情况、并发症、远期疗效及治疗前后血肌酐水平。结果观察组患者手术时间、住院时间短于对照组,手术出血量、术后引流量少于对照组(P <0. 05)。对照组和观察组患者并发症发生率分别为12. 5%(4/32)、9. 4%(3/32),2组患者术后并发症发生率比较差异无统计学意义(χ~2=0. 481,P> 0. 05)。术前2组患者血肌酐水平比较差异无统计学意义(P> 0. 05);观察组和对照组患者术后1 d及3、6个月血肌酐水平均高于术前(P <0. 05);术后1 d和术后3、6个月观察组患者血肌酐水平均低于对照组(P <0. 05)。观察组患者术后3、5 a生存率及5 a复发率分别为93. 8%(30/32)、90. 6%(29/32)、3. 1%(1/32),对照组患者术后3、5 a生存率及5 a复发率分别为90. 6%(29/32)、87. 5%(28/32)、6. 2%(2/32);2组患者术后3、5 a生存率及5 a复发率比较差异均无统计学意义(χ~2=0. 312、0. 440、0. 503,P> 0. 05)。结论腹腔镜下保留肾单位手术治疗老年局限性肾癌效果佳,并发症少,对肾功能的影响也较小,患者远期生存率较高。
Objective To explore the efficacy of laparoscopic nephron sparing surgery for treatment of elderly patients with localized renal carcinoma. Methods Sixty-four elderly patients with localized renal carcinoma in the Affiliated Hospital of Yangzhou University and the Second Hospital of Nanjing from January 2011 to January 2013 were selected and divided into observation group and control group,with 32 patients in each group. The patients in the observation group were treated with laparoscopic nephron sparing surgery,the patients in the control group were treated with open nephron sparing surgery. The surgery conditions,complication,long-term efficacy and the levels of serum creatinine before and after treatment were compared between the two groups. Results The operation time,hospitalization time of patients in the observation group were shorter than those in the control group( P < 0. 05),the surgical bleeding volume,postoperative drainage volume of patients in the observation group were less than those in the control group( P < 0. 05). The postoperative complication rate of the patients in the control group and observation group was 12. 5%( 4/32),9. 4%( 3/32) respectively; there was no statistic difference in the complications between the two groups( χ~2= 0. 481,P > 0. 05). There was no statistic difference in the levels of serum creatinine between the two groups before operation( P > 0. 05); the level of serum creatinine of patients at 1 day,3,6 months after operation was significantly higher than that before operation in the two groups( P < 0. 05); the level of serum creatinine of patients in the observation group was significantly lower than that in the control group at 1 day,3,6 months after operation( P <0. 05). The 3-year and 5-year survival rate and 5-year recurrence rates of patients in the observation group after surgery was 93. 8%( 30/32),90. 6%( 29/32) and 3. 1%( 1/32); and it was 90. 6%( 29/32),87. 5%( 28/32) and 6. 2%( 2/32) in the control group. There was no significant difference in the 3-year,5-year survival rates and 5-year recurrence rates after surgery between the two groups( χ~2= 0. 312,0. 440,0. 503; P > 0. 05). Conclusion Endoscopic nephron sparing surgery for localized renal cell carcinoma in the elderly patients has a good effect. It has the advantages of rapid recovery,fewer complications,less impact on renal function,and higher long-term survival.
Objective To explore the efficacy of laparoscopic nephron sparing surgery for treatment of elderly patients with localized renal carcinoma. Methods Sixty-four elderly patients with localized renal carcinoma in the Affiliated Hospital of Yangzhou University and the Second Hospital of Nanjing from January 2011 to January 2013 were selected and divided into observation group and control group,with 32 patients in each group. The patients in the observation group were treated with laparoscopic nephron sparing surgery,the patients in the control group were treated with open nephron sparing surgery. The surgery conditions,complication,long-term efficacy and the levels of serum creatinine before and after treatment were compared between the two groups. Results The operation time,hospitalization time of patients in the observation group were shorter than those in the control group( P < 0. 05),the surgical bleeding volume,postoperative drainage volume of patients in the observation group were less than those in the control group( P < 0. 05). The postoperative complication rate of the patients in the control group and observation group was 12. 5%( 4/32),9. 4%( 3/32) respectively; there was no statistic difference in the complications between the two groups( χ~2= 0. 481,P > 0. 05). There was no statistic difference in the levels of serum creatinine between the two groups before operation( P > 0. 05); the level of serum creatinine of patients at 1 day,3,6 months after operation was significantly higher than that before operation in the two groups( P < 0. 05); the level of serum creatinine of patients in the observation group was significantly lower than that in the control group at 1 day,3,6 months after operation( P <0. 05). The 3-year and 5-year survival rate and 5-year recurrence rates of patients in the observation group after surgery was 93. 8%( 30/32),90. 6%( 29/32) and 3. 1%( 1/32); and it was 90. 6%( 29/32),87. 5%( 28/32) and 6. 2%( 2/32) in the control group. There was no significant difference in the 3-year,5-year survival rates and 5-year recurrence rates after surgery between the two groups( χ~2= 0. 312,0. 440,0. 503; P > 0. 05). Conclusion Endoscopic nephron sparing surgery for localized renal cell carcinoma in the elderly patients has a good effect. It has the advantages of rapid recovery,fewer complications,less impact on renal function,and higher long-term survival.
引文
[1]洪英楷.保留肾单位手术治疗T1期局限性肾癌近远期疗效[J].中国城乡企业卫生,2017,32(1):123-124.
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[3]梁涛,李作为,胡晓勇,等.保留肾单位手术在老年患者中的应用分析[J].中国现代医学杂志,2017,27(7):103-106.
[4]蒋峥,米华.腹腔镜保留肾单位术与根治术治疗局限性肾癌的临床疗效比较[J].广西医科大学学报,2015,32(2):286-288.
[5]高嘉林,安伟,傅耀文,等.后腹腔镜保留肾单位手术治疗老年T1a期肾癌的疗效[J].中国老年学杂志,2017,37(15):3822-3823.
[6]黄建林,安宇,廖勇,等.后腹腔镜保留肾单位手术治疗70岁以上老年局限性肾癌[J].中国微创外科杂志,2017,17(8):748-751.
[7]王忠尧,蔡德海,冯雄,等.保留肾单位手术对早期肾癌患者的肾功能及远期效果观察[J].中国地方病防治杂志,2017,32(5):584-586.
[8]陈慧瑛.保留肾单位手术治疗T1期局限性肾癌的围术期护理[J].实用临床医药杂志,2017,21(18):69-71.
[9]梁杰.保留肾单位手术与肾癌根治术治疗局限性肾癌疗效对比分析[J].吉林医学,2017,38(11):2138-2140.
[10]王先龙,姜福全,张刚,等.老年患者腹腔镜与开放肾部分切除术治疗局限性肾癌安全性及疗效对比[J].中国老年学杂志,2016,36(5):1122-1124.
[11]代宏,余志海,何东林,等.三种保留肾单位术式对局限性肾癌疗效及安全性的对照研究[J].癌症进展,2016,14(8):790-792.
[12]王天喜,汪永清,冀强,等.后腹腔镜下肾部分切除术治疗老年肾癌的安全性及近远期疗效[J].中国老年学杂志,2018(2):363-365.
[13]钟震海,张春阳,钟震宇.保留肾单位手术与根治性肾切除术治疗局限性肾癌的临床比较分析[J].中国医学工程,2012,20(8):1-3,9.
[14]吴金光.老年肾癌患者开放手术与后腹腔镜手术的疗效比较[J].河北医药,2013,35(9):1346-1347.
[15]宋希双,毕波,殷积斌,等.保留肾单位肾癌切除术的疗效与随访[J].中华泌尿外科杂志,2005(10):683-685.
[16]吴岑,伍伯聪,苏仲宁,等.腹腔镜保留肾单位手术治疗老年患者局限性肾癌13例[J].中国老年学杂志,2013,33(17):4326-4327.
[17]那彦群,叶章群,孙颖浩,等.中国泌尿外科疾病诊断治疗指南[M].北京:人民卫生出版社,2014:11-12.
[18]梁涛,李作为,胡晓勇,等.保留肾单位手术在老年患者中的应用分析[J].中国现代医学杂志,2017,27(7):103-106.
[2]张豪杰,盛璐,陈然,等.机器人辅助腹腔镜肾部分治疗老年T1a期肾癌15例报道兼文献复习[J].老年医学与保健,2016,22(6):401-404.
[3]梁涛,李作为,胡晓勇,等.保留肾单位手术在老年患者中的应用分析[J].中国现代医学杂志,2017,27(7):103-106.
[4]蒋峥,米华.腹腔镜保留肾单位术与根治术治疗局限性肾癌的临床疗效比较[J].广西医科大学学报,2015,32(2):286-288.
[5]高嘉林,安伟,傅耀文,等.后腹腔镜保留肾单位手术治疗老年T1a期肾癌的疗效[J].中国老年学杂志,2017,37(15):3822-3823.
[6]黄建林,安宇,廖勇,等.后腹腔镜保留肾单位手术治疗70岁以上老年局限性肾癌[J].中国微创外科杂志,2017,17(8):748-751.
[7]王忠尧,蔡德海,冯雄,等.保留肾单位手术对早期肾癌患者的肾功能及远期效果观察[J].中国地方病防治杂志,2017,32(5):584-586.
[8]陈慧瑛.保留肾单位手术治疗T1期局限性肾癌的围术期护理[J].实用临床医药杂志,2017,21(18):69-71.
[9]梁杰.保留肾单位手术与肾癌根治术治疗局限性肾癌疗效对比分析[J].吉林医学,2017,38(11):2138-2140.
[10]王先龙,姜福全,张刚,等.老年患者腹腔镜与开放肾部分切除术治疗局限性肾癌安全性及疗效对比[J].中国老年学杂志,2016,36(5):1122-1124.
[11]代宏,余志海,何东林,等.三种保留肾单位术式对局限性肾癌疗效及安全性的对照研究[J].癌症进展,2016,14(8):790-792.
[12]王天喜,汪永清,冀强,等.后腹腔镜下肾部分切除术治疗老年肾癌的安全性及近远期疗效[J].中国老年学杂志,2018(2):363-365.
[13]钟震海,张春阳,钟震宇.保留肾单位手术与根治性肾切除术治疗局限性肾癌的临床比较分析[J].中国医学工程,2012,20(8):1-3,9.
[14]吴金光.老年肾癌患者开放手术与后腹腔镜手术的疗效比较[J].河北医药,2013,35(9):1346-1347.
[15]宋希双,毕波,殷积斌,等.保留肾单位肾癌切除术的疗效与随访[J].中华泌尿外科杂志,2005(10):683-685.
[16]吴岑,伍伯聪,苏仲宁,等.腹腔镜保留肾单位手术治疗老年患者局限性肾癌13例[J].中国老年学杂志,2013,33(17):4326-4327.
[17]那彦群,叶章群,孙颖浩,等.中国泌尿外科疾病诊断治疗指南[M].北京:人民卫生出版社,2014:11-12.
[18]梁涛,李作为,胡晓勇,等.保留肾单位手术在老年患者中的应用分析[J].中国现代医学杂志,2017,27(7):103-106.