腹膜后肾肿瘤切除术与经腹肾肿瘤切除术治疗小儿双侧肾母细胞瘤的疗效比较及预后分析

Curative effect and prognosis comparison in treating children with bilateral Wilms tumor by retroperitoneal nephrectomy or transabdominal nephrectomy

目的探讨腹膜后肾肿瘤切除术与经腹肾肿瘤切除术在小儿双侧肾母细胞瘤中的临床应用及疗效。方法回顾性分析1997年4月至2014年7月入住郑州大学第一附属医院小儿外科的27例双侧肾母细胞瘤患儿的临床资料，其中9例行经腹膜后肿瘤切除术（研究组），18例行经腹肿瘤切除（对照组），比较不同术式患儿围手术期各项临床参数及生存资料。结果研究组患儿手术时间[（129．5±13．9）min]、术后ICU时间[（6．3±3．1）d]、住院时间[（13．9±3．9）d]及肠功能恢复时间[（6．8±3．4）d]均明显低于对照组[（149．5±26．7）min、（9．7±3．8）d、（20．5±3．0）d、（11．5±3．1）d]，2组比较差异均有统计学意义（t=2．129，P=0．051；t=2．551，P=0．017；t=4．489，P〈0．001；t=3．488，P=0．002）。研究组患儿术中出血量[（95．5±14．6）mL]、术后肾功能恢复时间[（22．3±3．1）d]及随访平均肌酐水平[（67．0±21．3）μmol／L]均低于对照组[（105．9±23．1）mL、（24．7±4．5）d、（76．8±13．3）μmol／L]，2组比较差异均无统计学意义（t=1．231、1．485、1．474，P=0．243、0．163、0．154）。研究组患儿术中不良事件发生率[0（0／9例）]、术后尿漏并发症发生率[11．1％（1／9例）]均低于对照组[11．1％（2／18例）、16．7％（3／18例）]，但2组比较差异无统计学意义（P=0．103、0．093）。研究组患儿中位生存时间高于对照组，且平均累计生存风险低于对照组（28．5个月，95％CI：23．2-33．7个月比22．4个月，95％CI：12．6—32．1个月；χ2=0．469，P=0．494）。结论经腹膜后肿瘤切除术可降低手术、术后ICU及住院时间，避免了肠操作，减少术后肠粘连并发症概率及经口进食等待时间，可作为一种治疗小儿双侧肾母细胞瘤可行的手术方式。

Objective To explore the clinical application and efficacy in the treatment of children with bilate- ral Wilms tumor（BWT） by retroperitoneal nephrectomy or transabdominal nephrectomy. Methods Clinical data of 27 children with BWT in which 9 cases underwent retroperitoneal nephrectomy （study group） while 18 cases underwent transabdominal nephreetomy （control group） at Department of Pediatric Surgery, the First Affiliated Hospital of Zheng- zhou University from April 1997 to July 2014 were retrospectively analyzed. The perioperative clinical parameters and survival data were compared between the study group and the control group. Results The operation duration [ （129.5 ± 13.9） mini ,the length of intensive care unit （ICU） postoperatively [ （6.3 ± 3. 1 ） d], hospital stay [ （ 13.9 ±3.9 ） d] and the time to resuming an oral diet[ （6.8 ± 3.4） d] of the study group were markedly lower than those of the control group [ （ 149.5 ± 26. 7） rain, （9.7± 3.8 ） d, （20.5 ± 3.0） d, （ 11.5 ± 3.1 ） d ], and the diffe- rences were statistically significant （ t = 2. 129, P = 0.051 ; t = 2.551, P = 0.017 ; t = 4. 489, P 〈 0.001 ; t = 3. 488, P = 0. 002）. The estimated blood loss [ （95.5 ± 14. 6 ） mL], postoperative renal recovery time [ （22.3 ± 3. 1 ） d ] and mean serum creatinine levels by follow - up [ （67. 0 ± 21.3） μmol/L] of study group were lower than those of the con- trol group [ （ 105.9 ± 23.1 ） mL, （24.7 ±4. 5 ） d, （76.8 ± 13.3 ） μmol/L], but the differences were not significant （ t = 1.231,1. 485,1. 474,P = 0. 243,0. 163,0. 154 ）. There was a similar tendency that intraoperative adverse event rates [ 0 （0/9 cases） ] and postoperative urine leakage rates [ 11.1% （1/9 cases） ] of the study group were lower than those of the control group [ 11.1% （2/18 cases）, 16. 7% （ 3/18 cases） ], but the differences were not significant （ P = 0. 103,0. 093）. Study group revealed longer median survival time than that of the control group and cumulative survival hazard of study group was lower than that of the control group （28.5 months ,95% CI：23.2 - 33.7 months vs 22.4 months ,95% CI：12.6 - 32. 1 months ;χ2 = 0.469,P = 0. 494）. Conclusions Retroperitoneal nephrectomy provides valuable benefits clini- cally, including shorter operative time, postoperative length of ICU and hospital stays, avoidance of bowel injuries, and less adhesions and shorter time to resuming an oral diet over the transabdominal counterpart, which can be considered a viable surgical option for treatment of BWT.