微波消融辅助零缺血腹腔镜肾部分切除术对T1期肾细胞癌的应用效果分析

Analysis the effect of microwave ablation assisted zero ischemi laparoscopic partial nephrectomy on T1 renal cell carcinoma

目的:探讨微波消融辅助零缺血腹腔镜肾部分切除术在T1期肾细胞癌(RC)治疗中的应用价值。方法:入选2020年8月至2022年8月我院T1期RC患者106例,随机数表法分为A组和B组,每组53例。A组行微波消融辅助零缺血腹腔镜肾部分切除术(MWN-LPN),B组行传统LPN。比较两组围手术期指标、并发症、肿瘤复发情况、手术前后第三间隙效应指标[钠离子(Na^(+))、钙离子(Ca^(2+))、钾离子(K^(+))、白蛋白(ALB)、前白蛋白(PA)]、肾功能指标[血清肌酐(Scr)、肾小球滤过率(GFR)]、肿瘤标志物[癌抗原(CA50)、CA199、甲胎蛋白(AFP)]水平。结果:相比B组,A组术后3 d血红蛋白(Hb)、血清Na^(+)、Ca^(2+)、ALB、PA、术后3 d、5 d Scr和GFR水平高,术后3d的K^(+)水平低,差异均具有统计学意义(P<0.05)。相比术前,两组术后1月和3月血清CA50、CA199、AFP水平下降,差异均具有统计学意义(P<0.05)。A组并发症发生率低于B组[1.89%(1/53)vs.16.98%(9/53)],差异具有统计学意义(P<0.05)。结论:MWN-LPN与传统LPN治疗T1期RC均能获得理想的肿瘤清除效果,但前者无热缺血现象,可降低对第三间隙效应指标的影响,减轻术后肾功能损伤,降低并发症风险。

Objective:To explore the value of microwave ablationassisted zero ischemic laparoscopic partial nephrectomy in the treatment of T1 renal cell carcinoma(RC).Methods:106 patients with T1 renal cell carcinoma in our hospital from August 2020 to August 2022 were selectedand divided into A and B group by random number table,with 53 cases in each group.Microwave ablationassisted zero ischemia laparoscopic partial nephrectomy(MWNLPN)was performed in group A,and traditional laparoscopic partial nephrectomy(LPN)was performed in group B.Perioperative indicators,complications and tumor recurrence,the third space indicators[sodium(Na+),calcium(Ca2+),potassium(K+),albumin(ALB),prealbumin(PA)],renal function indicators[serum creatinine(Scr),estimated glomerular filtration rate(GFR)],tumor markers[cancer antigen(CA50),CA199,alpha-fetoprotein(AFP)]before and after surgery were compared between the two groups.Results:Compared with group B,group A had higher hemoglobin(Hb),serum Na+,Ca2+,ALB,PA on postoperative day3,Scr and GFR on postoperative day3 and day5,and lower K+on day3,with statistical significance(P<0.05).Compared with preoperative,levels of serum CA50,CA199,and AFP decreased at 1 and 3 months after operationin both group,and the differences were significant(P<0.05).The incidence rate of complications was lower in group A than that of group B[1.89%(1/53)vs.16.98%(9/53);P<0.05].Conclusion:Both MWN-LPN and traditional LPN can achieve ideal tumor clearance effect in the treatment of T1 renal cell carcinoma,but the former has no thermal ischemia phenomenon,which can reduce the influence on the third space effect,reduce postoperative renal injury and reduce the risk of complications.