腹腔镜下保留肾单位手术与根治性肾切除术治疗新发局限性肾癌的临床效果分析
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摘要
目的探讨腹腔镜下保留肾单位手术(NSS)与根治性肾切除术(RN)治疗新发局限性肾癌的临床效果。方法选择2015年1月至2017年6月西安交通大学第二附属医院收治的新发局限性肾癌患者220例,根据手术方式不同将220例患者分为腹腔镜下NSS组(观察组95例)和腹腔镜下RN组(对照组125例),比较2组患者手术时间、术中出血量、手术前后血肌酐水平的差异,术后门诊随访观察患者肿瘤转移及复发情况。结果 2组患者中转开腹及术后并发症发生率以及引流时间、术后禁食时间和住院时间比较差异均无统计学意义(均P>0.05),观察组手术时间长于对照组、术中出血量多于对照组[(117±23)min比(86±32)min,(98±24)ml比(71±12)ml],差异均有统计学意义(均P<0.05)。术前观察组与对照组患者血肌酐水平[(95±12)μmol/L比(98±12)μmol/L]比较差异无统计学意义(P>0.05)。术后1 d和术后3、6个月,2组血肌酐水平均高于术前,但观察组低于对照组[(112±17)μmol/L比(124±18)μmol/L,(110±14)μmol/L比(120±15)μmol/L,(108±13)μmol/L比(120±14)μmol/L],差异均有统计学意义(均P<0.05)。术后随访6～24个月,2组均无肿瘤复发、转移及死亡。结论腹腔镜下NSS和RN均可有效治疗局限型肾癌,但相对RN,NSS可减轻对患者肾功能的损伤,更有利于患者预后。
Objective To analyze the clinical effects of laparoscopic nephron-sparing surgery( NSS) and radical nephrectomy( RN) on localized renal carcinoma. Methods A total of 220 patients with localized renal carcinoma admitted between January 2015 and June 2017 in the Second Affiliated Hospital of Xi'an Jiaotong University were randomly divided into observation group(n =95) and control group(n = 125). The observation group was treated with laparoscopic NSS and the control group was treated with laparoscopic RN. Operation time,intraoperative blood loss, serum creatinine level, metastasis and recurrence were analyzed. Results Conversion to laparotomy rate, postoperative incidence of complications, drainage volume, fasting time and hospital stay time showed no significant differences between groups(P >0. 05). Operation time in observation group was significantly longer and intraoperative blood loss was significantly more than those in control group[(117 ±23) min vs(86 ±32) min,(98 ±24) ml vs(71 ± 12) ml](P <0. 05). Before surgery, serum creatinine had no significant between observation group and control group [( 95 ± 12) μmol/L vs( 98 ± 12) μmol/L ]( P > 0. 05). One day and 3,6 months after surgery, serum creatinine level was significantly higher than that before surgery; serum creatinine levels in observation group were significantly lower than those in control group [( 112 ± 17) μmol/L vs( 124 士18) μmol/L,(110 ± 14) μmol/L vs( 120 ± 15) μmol/L,( 108 ± 13) μmol/L vs( 120 ± 14) μmol/L]( P <0. 05). No tumor recurrence, metastasis and death occurred during 6-24 months of follow-up. Conclusions Both laparoscopic RN and NSS are effective in treatment of localized renal carcinoma. NSS can reduce renal damage more effectively than RN.
Objective To analyze the clinical effects of laparoscopic nephron-sparing surgery( NSS) and radical nephrectomy( RN) on localized renal carcinoma. Methods A total of 220 patients with localized renal carcinoma admitted between January 2015 and June 2017 in the Second Affiliated Hospital of Xi'an Jiaotong University were randomly divided into observation group(n =95) and control group(n = 125). The observation group was treated with laparoscopic NSS and the control group was treated with laparoscopic RN. Operation time,intraoperative blood loss, serum creatinine level, metastasis and recurrence were analyzed. Results Conversion to laparotomy rate, postoperative incidence of complications, drainage volume, fasting time and hospital stay time showed no significant differences between groups(P >0. 05). Operation time in observation group was significantly longer and intraoperative blood loss was significantly more than those in control group[(117 ±23) min vs(86 ±32) min,(98 ±24) ml vs(71 ± 12) ml](P <0. 05). Before surgery, serum creatinine had no significant between observation group and control group [( 95 ± 12) μmol/L vs( 98 ± 12) μmol/L ]( P > 0. 05). One day and 3,6 months after surgery, serum creatinine level was significantly higher than that before surgery; serum creatinine levels in observation group were significantly lower than those in control group [( 112 ± 17) μmol/L vs( 124 士18) μmol/L,(110 ± 14) μmol/L vs( 120 ± 15) μmol/L,( 108 ± 13) μmol/L vs( 120 ± 14) μmol/L]( P <0. 05). No tumor recurrence, metastasis and death occurred during 6-24 months of follow-up. Conclusions Both laparoscopic RN and NSS are effective in treatment of localized renal carcinoma. NSS can reduce renal damage more effectively than RN.
引文
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[7]蒋杰宏,黎灿强,杨毅.无功能积水肾腹膜后腹腔镜下肾切除术的特点及临床应用[J].中国医药,2015,10(12):1822-1824.DOI:10.3760/cma.j.issn.1673-4777.2015.12.027.Jiang JH,Li CQ,Yang Y.Clinical study on retroperitoneal laparoscopic nephrectomy of nonfunctional kidney with giant hydronephmsis[J].China Medicine,2015,10(12):1822-1824.DOI:10.3760/cma.j.issn.16734777.2015.12.027.
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[9]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.Zhong ZH,Zhang CY,Zhong ZY.Comparative analysis of renal cell surgery with radical nephrectomy for the treatment of localized renal carcinoma[J].China Medical Engineering,2012,20(8):1-3,9.
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[11]沈弋桢.保留肾单位手术和肾癌根治手术治疗局限性肾癌的临床疗效[J].医学综述,2015,21(7):1292-1293.DOI:10.3969/j.issn.1006-2084.2015.07.055.Shen YZ.Clinical comparison of nephron sparing surgery and radical nephrectomy in the treatment for patients with focal renalcarcinoma[J].Medical Recapitulate,2015,21(7):1292-1293.DOI:10.3969/j.issn.1006-2084.2015.07.055.
[12]李州利,蔡明,陈昌庆,等.后腹腔镜及开放保留肾单位手术治疗T1aNOMO期肾癌的临床疗效比较[J].临床泌尿外科杂志,2014,29(3):196-199.DOI:10.13201/j.issn.1001-1420.2014.03.004.Li ZL,Cai M,Chen CQ,et al.Comparison of clinical efficacy of retroperitoneoscope and open kidney preserving unit operation in the treatment of stage T1aNOMO renal carcinoma[J].Journal of Clinical Urology,2014,29(3):196-199.DOI:10.13201/j.issn.1001-1420.2014.03.004.
[13]钟林,王娟英,宋斌,等.后腹腔镜下保留肾单位肾部分切除术后肾功能的影响因素分析[J].现代生物医学进展,2014,14(27):5264-5266.DOI:10.13241/j.cnki.pmb.2014.27.017.Zhong L,Wang JY,Song B,et al.Protection after laparoscopic partial nephrectomy in renal units reserved postoperative renal function[J].Progress in Modern Biomedicine,2014,14(27):5264-5266.DOI:10.13241/j.cnki.pmb.2014.27.017.
[14]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.DOI:10.3969/j.issn.2095-5146.2015.06.017.Wang YP,Chen GF,Zhang X,et al.Protection of renal function after laparoscopic partial nephrectomy[J].Journal of Minimally Invasive Urology,2015,4(6):380-384.DOI:10.3969/j.issn.2095-5146.2015.06.017.
[15]高嘉林,安伟,傅耀文,等.后腹腔镜保留肾单位手术治疗老年Tla期肾癌的疗效[J].中国老年学杂志,2017,37(15):3822-3823.DOI:10.3969/j.issn.1005-9202.2017.15.080.Gao JL,An W,Fu YW,et al.The effect of retroperitoneal laparoscopic renal unit operation on the treatment of T1 a renal carcinoma in the elderly[J].Chinese Journal of Gerontology,2017,37(15):3822-3823.DOI:10.3969/j.issn.1005-9202.2017.15.080.
[16]Osawa T,Harada H,Oba K,et al.Clinical factor affecting the recovery of kidney function in clinically localized renal cell carcinoma patients who underwent nephron-sparing surgery[J].Hokkaido Igaku Zasshi,2013,88(1):15-20.
[17]杨书坤,王明.肾癌保留肾单位手术与根治性肾切除手术的诊疗比较[J].第三军医大学学报,2014,36(23):2404-2407.Yang SK,Wang M.Nephron-sparing surgery vs radical nephrectomy in patients with renal cell carcinoma:diagnosis and treatment[J].Journal of Third Military Medical University,2014,36(23):2404-2407.
[18]戢金瓯,成萍.保留肾单位手术与根治性肾切除术对T1b期肾癌患者血清炎症因子、肿瘤恶性生物学行为的影响[J].海南医学院学报,2014,20(12):1724-1726.DOI:10.13210/j.cnki.jhmu.20141010.019.Ji JO,Cheng P.Effect of nephron sparing operation and radical nephrectomy on inflammatory factors and malignant tumor biological behavior of stage T1b renal cell carcinoma[J].Journal of Hainan Medical University,2014,20(12):1724-1726.DOI:10.13210/j.cnki.jhmu.20141010.019.
[2]van Oostenbrugge TJ,Kroeze SG,Bosch JL,et al.The blind spots in follow-up after nephrectomy or nephron-sparing surgery for localized renal cell carcinoma[J].World J Urol,2015,33(6):881-887.DOI:10.1007/s00345-014-1390-6.
[3]Meyer A,Woldu SL,Weinberg AC,et al.Predicting renal parenchymal loss after nephron sparing surgery[J].J Urol,2015,194(3):658-663.DOI:10.1016/j.juro.2015.03.098.
[4]王成元,赵振立,王志勇,等.后腹腔镜保留肾单位手术治疗肾肿瘤疗效观察[J].山东医药,2015,55(26):39-40.DOI:10.3969/j.issn.1002-266X.2015.26.012.Wang CY,Zhao ZL,Wang ZY,et al.Therapeutic effect of retroperitoneal laparoscopic renal unit operation on renal tumor[J].Shandong Medical Journal,2015,55(26):39-40.DOI:10.3969/j.issn.1002-266X.2015.26.012.
[5]黄翼然,张进,陈勇辉,等.“球冠状”肾部分切除术治疗早期肾癌的临床研究[J].中华泌尿外科杂志,2015,36(3):166-171.DOI:10.3760/cma.j.issn.1000-6702.2015.03.003.Huang YR,Zhang J,Chen YH,et al.Novel Hat-Spherical partial nephrectomy for localized kidney cancer treatment[J].Chinese Journal of Urology,2015,36(3):166-171.DOI:10.3760/cma.j.issn.1000-6702.2015.03.003.
[6]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.Wang ZY,Cai DH,Feng X,et al.Observation of renal function and long-term effect of renal unit operation on early renal cancer patients[J].Chinese Journal of Control of Endemic Diseases,2017,32(5):584-586.
[7]蒋杰宏,黎灿强,杨毅.无功能积水肾腹膜后腹腔镜下肾切除术的特点及临床应用[J].中国医药,2015,10(12):1822-1824.DOI:10.3760/cma.j.issn.1673-4777.2015.12.027.Jiang JH,Li CQ,Yang Y.Clinical study on retroperitoneal laparoscopic nephrectomy of nonfunctional kidney with giant hydronephmsis[J].China Medicine,2015,10(12):1822-1824.DOI:10.3760/cma.j.issn.16734777.2015.12.027.
[8]葛学凯,周文生.后腹腔镜与开放肾癌根治术治疗局限性肾癌的临床疗效比较[J].中华全科医学,2016,14(10):1651-1653.DOI:10.16766/j.cnki.issn.1674-4152.2016.10.014.Ge XK,Zhou WS.Retroperitoneal laparoscopic versus open nephrectomy for localized renal cell carcinoma[J].Chinese Journal of General Practice,2016,14(10):1651-1653.DOI:10.16766/j.cnki.issn.1674-4152.2016.10.014.
[9]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.Zhong ZH,Zhang CY,Zhong ZY.Comparative analysis of renal cell surgery with radical nephrectomy for the treatment of localized renal carcinoma[J].China Medical Engineering,2012,20(8):1-3,9.
[10]那彦群,叶章群,孙光,等.2011版中国泌尿外科疾病诊断治疗指南手册[M].北京:人民卫生出版社,2011:10-19.Na YQ,Ye ZQ,Sun G,et al.2011 edition of Chinese department of urology guide to diagnosis and treatment of diseases[M].Beijing:People's Medical Publishing House,2011:10-19.
[11]沈弋桢.保留肾单位手术和肾癌根治手术治疗局限性肾癌的临床疗效[J].医学综述,2015,21(7):1292-1293.DOI:10.3969/j.issn.1006-2084.2015.07.055.Shen YZ.Clinical comparison of nephron sparing surgery and radical nephrectomy in the treatment for patients with focal renalcarcinoma[J].Medical Recapitulate,2015,21(7):1292-1293.DOI:10.3969/j.issn.1006-2084.2015.07.055.
[12]李州利,蔡明,陈昌庆,等.后腹腔镜及开放保留肾单位手术治疗T1aNOMO期肾癌的临床疗效比较[J].临床泌尿外科杂志,2014,29(3):196-199.DOI:10.13201/j.issn.1001-1420.2014.03.004.Li ZL,Cai M,Chen CQ,et al.Comparison of clinical efficacy of retroperitoneoscope and open kidney preserving unit operation in the treatment of stage T1aNOMO renal carcinoma[J].Journal of Clinical Urology,2014,29(3):196-199.DOI:10.13201/j.issn.1001-1420.2014.03.004.
[13]钟林,王娟英,宋斌,等.后腹腔镜下保留肾单位肾部分切除术后肾功能的影响因素分析[J].现代生物医学进展,2014,14(27):5264-5266.DOI:10.13241/j.cnki.pmb.2014.27.017.Zhong L,Wang JY,Song B,et al.Protection after laparoscopic partial nephrectomy in renal units reserved postoperative renal function[J].Progress in Modern Biomedicine,2014,14(27):5264-5266.DOI:10.13241/j.cnki.pmb.2014.27.017.
[14]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.DOI:10.3969/j.issn.2095-5146.2015.06.017.Wang YP,Chen GF,Zhang X,et al.Protection of renal function after laparoscopic partial nephrectomy[J].Journal of Minimally Invasive Urology,2015,4(6):380-384.DOI:10.3969/j.issn.2095-5146.2015.06.017.
[15]高嘉林,安伟,傅耀文,等.后腹腔镜保留肾单位手术治疗老年Tla期肾癌的疗效[J].中国老年学杂志,2017,37(15):3822-3823.DOI:10.3969/j.issn.1005-9202.2017.15.080.Gao JL,An W,Fu YW,et al.The effect of retroperitoneal laparoscopic renal unit operation on the treatment of T1 a renal carcinoma in the elderly[J].Chinese Journal of Gerontology,2017,37(15):3822-3823.DOI:10.3969/j.issn.1005-9202.2017.15.080.
[16]Osawa T,Harada H,Oba K,et al.Clinical factor affecting the recovery of kidney function in clinically localized renal cell carcinoma patients who underwent nephron-sparing surgery[J].Hokkaido Igaku Zasshi,2013,88(1):15-20.
[17]杨书坤,王明.肾癌保留肾单位手术与根治性肾切除手术的诊疗比较[J].第三军医大学学报,2014,36(23):2404-2407.Yang SK,Wang M.Nephron-sparing surgery vs radical nephrectomy in patients with renal cell carcinoma:diagnosis and treatment[J].Journal of Third Military Medical University,2014,36(23):2404-2407.
[18]戢金瓯,成萍.保留肾单位手术与根治性肾切除术对T1b期肾癌患者血清炎症因子、肿瘤恶性生物学行为的影响[J].海南医学院学报,2014,20(12):1724-1726.DOI:10.13210/j.cnki.jhmu.20141010.019.Ji JO,Cheng P.Effect of nephron sparing operation and radical nephrectomy on inflammatory factors and malignant tumor biological behavior of stage T1b renal cell carcinoma[J].Journal of Hainan Medical University,2014,20(12):1724-1726.DOI:10.13210/j.cnki.jhmu.20141010.019.