后腹腔镜肾部分切除术与开放肾部分切除术治疗局限性肾癌的疗效分析
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摘要
目的探讨后腹腔镜肾部分切除术与开放肾部分切除术治疗局限性肾癌的疗效。方法将入院的80例局限性肾癌患者随机分为2组,后腹腔镜组患者予以后腹腔镜肾部分切除术,开放组患者则予以开放肾部分切除术,比较2组患者围术期指标、血红蛋白(Hb)、肌酐(Cr)水平、生存率与远期生存质量。结果后腹腔镜组患者下床时间、肾窝引流总量与术后住院时间均显著性低于开放组;术后Hb水平显著高于开放组,Cr水平显著低于开放组; 1年总生存率显著高于开放组;术后1年躯体领域与角色领域评分均显著高于开放组,疲倦、疼痛与失眠评分均显著低于开放组,差异均有统计学意义(P <0. 05)。结论与开放肾部分切除术比较,后腹腔镜肾部分切除术治疗局限性肾癌的恢复效率更高,远期生存率与生存质量更优。
Objective To investigate the efficacy of retroperitoneoscopic partial nephrectomy versus open partial nephrectomy for localized renal carcinoma. Methods Eighty patients with localized renal cancer were randomly divided into two groups. Patients in the retroperitoneoscopic group were treated with partial laparoscopic nephrectomy,those in the open group were treated with open partial nephrectomy. The perioperative indicators,hemoglobin( Hb),creatinine( Cr),survival,and long-term quality of life were compared between the two groups. Results Retroperitoneoscopic group had shorter bed-off time and postoperative hospital stay,and less total renal drain volume than the open group. Postoperative Hb level was significantly higher,and Cr level was significantly lower than the open group( P < 0. 05). The 1-year overall survival rate was significantly higher,the scores in the somatic and role areas at 1 year after surgery were significantly higher than those in the open group,and the scores for fatigue,pain,and insomnia were significantly lower than that in the open group( P < 0. 05). Conclusion Compared with open partial nephrectomy,retroperitoneoscopic partial nephrectomy has better efficacy,long-term survival rate and quality of life.
Objective To investigate the efficacy of retroperitoneoscopic partial nephrectomy versus open partial nephrectomy for localized renal carcinoma. Methods Eighty patients with localized renal cancer were randomly divided into two groups. Patients in the retroperitoneoscopic group were treated with partial laparoscopic nephrectomy,those in the open group were treated with open partial nephrectomy. The perioperative indicators,hemoglobin( Hb),creatinine( Cr),survival,and long-term quality of life were compared between the two groups. Results Retroperitoneoscopic group had shorter bed-off time and postoperative hospital stay,and less total renal drain volume than the open group. Postoperative Hb level was significantly higher,and Cr level was significantly lower than the open group( P < 0. 05). The 1-year overall survival rate was significantly higher,the scores in the somatic and role areas at 1 year after surgery were significantly higher than those in the open group,and the scores for fatigue,pain,and insomnia were significantly lower than that in the open group( P < 0. 05). Conclusion Compared with open partial nephrectomy,retroperitoneoscopic partial nephrectomy has better efficacy,long-term survival rate and quality of life.
引文
[1]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.
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[4]王昌兵,顾恒,袁宇峰,等.后腹腔镜根治性肾切除术治疗局限性肾癌42例[J].中国内镜杂志,2014,20(1):107-108.
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[6]高旭,刘安.后腹腔镜根治性肾切除术治疗局限性肾癌的疗效研究[J].实用癌症杂志. 2017,33(2):339-341.
[7]高海捷,吴大鹏,朱国栋,等.后腹腔镜肾部分切除术与开放肾部分切除治疗局限性肾癌的安全性及疗效比较[J].现代泌尿外科杂志,2016,21(3):182-186.
[8]乔明洲,宋歌,张海芳.后腹腔镜肾部分切除术与开放手术治疗局限性肾癌的疗效比效[J].癌症进展,2017,15(8):936-938.
[9] Moskowitz E J,Paulucci D J,Reddy B N,et al. Predictors of Medical and Surgical Complications After Robot-Assisted Partial Nephrectomy:An Analysis of 1139 Patients in a Multi-Institutional Kidney Cancer Database[J]. J Endourol,2017,31(3):223-228.
[10]李亚军,宋勇,宋琳,等.后腹腔镜下肾部分切除术对局限性肾癌的疗效分析[J].实用癌症杂志,2014,30(11):1417-1419.
[11] Bansal R K,Tanguay S,Finelli A,et al. Positive Surgical Margins During Partial Nephrectomy for Renal Cell Carcinoma:Results From Canadian Kidney Cancer Information System(CKCis)Collaborative[J]. Can Urol Assoc J,2017,11(6):182-187.
[12]丰水强.局限性肾细胞癌肾切除后5年复发的临床特征和预后[J].现代泌尿生殖肿瘤杂志,2011,3(4):233-235.
[13] Abolhasani M,Salarinejad S,Asgari M. P53 and MDM2 Over-Expression and Five-Year Survival of Kidney Cancer Patients Undergoing Radical Nephrectomy--Iranian Experience[J]. Asian Pac J Cancer Prev,2015,16(12):5043-5047.
[14]王磊,郑昕,孙洵.后腹腔镜根治性与开放性肾切除术治疗局限性肾癌效果观察[J].现代诊断与治疗. 2013,24(3):675-677.
[15] Sidaway P. Kidney Cancer:Cytoreductive Nephrectomy Improves Outcomes in the Era of Targeted Therapy[J]. Nat Rev Urol,2016,13(8):438-440.
[16]陈汉忠,林富祥,刘久敏.腔镜超声辅助后腹腔镜肾部分切除术治疗中央型局限性肾癌1例并文献复习[J].国际泌尿系统杂志,2017,38(3):422-423.
[17] Bazzi W M,Chen L Y,Cordon B H,et al. Non-Neoplastic Parenchymal Changes in Kidney Cancer and Post-Partial Nephrectomy Recovery of Renal Function[J]. Int Urol Nephrol,2015,47(9):1499-1502.
[18]马超光,闫成智. 3D腹腔镜肾部分切除术治疗肾肿瘤(附11例报告)[J].中国微创外科杂志,2017,17(8):704-706,713.
[19]孙鹤云,邹建纲,苏彤,等.腹腔镜下肾部分切除术中倒刺缝线的应用研究[J].实用临床医药杂志,2016,20(23):103-104.
[20]魏礼杰,庞诗语,罗扬,等.肾部分切除术与肾癌根治术治疗局限性肾癌的预后比较的Meta分析[J].现代泌尿外科杂志,2015,20(6):402-408.
[2]黄兴,石洪波,王蕾,等.后腹腔镜根治性肾切除术与开放手术治疗局限性肾癌的疗效比较[J].现代泌尿生殖肿瘤杂志,2010,2(1):16-18.
[3]黄兴,王蕾,石洪波,等.后腹腔镜根治性肾切除术治疗局限性肾癌(附96例报告)[J].中国医药导刊,2011,13(12):2073-2074,2076.
[4]王昌兵,顾恒,袁宇峰,等.后腹腔镜根治性肾切除术治疗局限性肾癌42例[J].中国内镜杂志,2014,20(1):107-108.
[5] Rogers C G,Barod R,Schwartz S,et al. Reply to Pranav Sharma,Asad Sawar and Philippe Spiess'Letter to the Editor Re:Re:Craig Rogers,Ravi Barod,Scott Schwartz,Mani Menon. Endovascular Extraction of Caval Tumor Thrombus to Facilitate Minimally Invasive Cytoreductive Nephrectomy for Metastatic Kidney Cancer[J]. Eur Urol,2015,68(4):167-168.
[6]高旭,刘安.后腹腔镜根治性肾切除术治疗局限性肾癌的疗效研究[J].实用癌症杂志. 2017,33(2):339-341.
[7]高海捷,吴大鹏,朱国栋,等.后腹腔镜肾部分切除术与开放肾部分切除治疗局限性肾癌的安全性及疗效比较[J].现代泌尿外科杂志,2016,21(3):182-186.
[8]乔明洲,宋歌,张海芳.后腹腔镜肾部分切除术与开放手术治疗局限性肾癌的疗效比效[J].癌症进展,2017,15(8):936-938.
[9] Moskowitz E J,Paulucci D J,Reddy B N,et al. Predictors of Medical and Surgical Complications After Robot-Assisted Partial Nephrectomy:An Analysis of 1139 Patients in a Multi-Institutional Kidney Cancer Database[J]. J Endourol,2017,31(3):223-228.
[10]李亚军,宋勇,宋琳,等.后腹腔镜下肾部分切除术对局限性肾癌的疗效分析[J].实用癌症杂志,2014,30(11):1417-1419.
[11] Bansal R K,Tanguay S,Finelli A,et al. Positive Surgical Margins During Partial Nephrectomy for Renal Cell Carcinoma:Results From Canadian Kidney Cancer Information System(CKCis)Collaborative[J]. Can Urol Assoc J,2017,11(6):182-187.
[12]丰水强.局限性肾细胞癌肾切除后5年复发的临床特征和预后[J].现代泌尿生殖肿瘤杂志,2011,3(4):233-235.
[13] Abolhasani M,Salarinejad S,Asgari M. P53 and MDM2 Over-Expression and Five-Year Survival of Kidney Cancer Patients Undergoing Radical Nephrectomy--Iranian Experience[J]. Asian Pac J Cancer Prev,2015,16(12):5043-5047.
[14]王磊,郑昕,孙洵.后腹腔镜根治性与开放性肾切除术治疗局限性肾癌效果观察[J].现代诊断与治疗. 2013,24(3):675-677.
[15] Sidaway P. Kidney Cancer:Cytoreductive Nephrectomy Improves Outcomes in the Era of Targeted Therapy[J]. Nat Rev Urol,2016,13(8):438-440.
[16]陈汉忠,林富祥,刘久敏.腔镜超声辅助后腹腔镜肾部分切除术治疗中央型局限性肾癌1例并文献复习[J].国际泌尿系统杂志,2017,38(3):422-423.
[17] Bazzi W M,Chen L Y,Cordon B H,et al. Non-Neoplastic Parenchymal Changes in Kidney Cancer and Post-Partial Nephrectomy Recovery of Renal Function[J]. Int Urol Nephrol,2015,47(9):1499-1502.
[18]马超光,闫成智. 3D腹腔镜肾部分切除术治疗肾肿瘤(附11例报告)[J].中国微创外科杂志,2017,17(8):704-706,713.
[19]孙鹤云,邹建纲,苏彤,等.腹腔镜下肾部分切除术中倒刺缝线的应用研究[J].实用临床医药杂志,2016,20(23):103-104.
[20]魏礼杰,庞诗语,罗扬,等.肾部分切除术与肾癌根治术治疗局限性肾癌的预后比较的Meta分析[J].现代泌尿外科杂志,2015,20(6):402-408.