肾部分切除术治疗T_(1b)肾细胞癌的临床效果探讨

Clinical effect of partial nephrectomy in the treatment of T_(1b) renal cell carcinoma

目的探讨肾部分切除术治疗T_(1b)肾细胞癌(renal cell carcinoma,RCC)的有效性和安全性。方法回顾分析2012年1月至2020年12月在武警安徽省总队医院住院诊断为“肾细胞癌”且临床分期为T_(1b)N0M0的53例患者临床资料。行肾部分切除术患者29例,作为观察组;行根治性肾切除术24例,作为对照组。对两组患者一般情况、手术时间、术中出血量、术后肾功能、手术并发症、术后引流量、平均住院时间、术后复发率等进行比较。结果观察组术中出血量(216.63±27.41)ml,高于对照组的(150.06±15.32)ml;观察组术后引流时间(5.67±1.44)d,高于对照组的(2.78±1.40)d,差异均有统计学意义(P<0.05)。观察组术后1 d肾小球滤过率(91.71±6.88)ml/min,较术前下降(7.04±1.33)ml/min;对照组术后1 d肾小球滤过率(79.12±17.54)ml/min,较术前下降(19.09±4.11)ml/min;观察组均优于对照组,差异有统计学意义(P<0.05)。两组手术时间、术后并发症、住院时间、术后复发率差异无统计学意义(P>0.05)。结论肾部分切除术能够安全有效治疗T_(1b)RCC,术后肾功能相对较好,提高患者生活质量,可有选择地优先考虑。

Objective To explore the efficacy and safety of partial nephrectomy for T_(1b)renal cell carcinoma(RCC).Methods Clinical data of 53 patients diagnosed with RCC with clinical stage T_(1b)N0M0in Anhui Provincal Corps Hospital of Chinese People’s Armed Police Forces from January2012 to December 2020 were retrospectively analyzed.A total of 29 patients were performed by partial nephrectomy as observation group;radical nephrectomy was performed in 24 cases as control group.The general situation,operation time,intraoperative blood loss,postoperative renal function,surgical complications,postoperative drainage volume,average hospital stay and the recurrence rate of 2 groups were compared.Results The intraoperative blood loss in the observation group was(216.63±27.41)ml,which was higher than(150.06±15.32)ml in the control group.The postoperative drainage time in the observation group was(5.67±1.44)d,which was higher than(2.78±1.40)d in the control group.The above differences between the two groups were statistically significant(P<0.05).The glomerular filtration rate of the observation group was(91.71±6.88)ml/min 1 d after surgery,which was decreased by(7.04±1.33)ml/min compared with that before surgery.Meanwhile,the glomerular filtration rate of the control group was(79.12±17.54)ml/min 1 d after surgery,which was decreased by(19.09±4.11)ml/min compared with that before surgery.Therefore,observation group was better than control group(P<0.05).There were no significant differences in operation time,postoperative complications,hospital stay,and the recurrence rate between the two groups(P>0.05).Conclusions Partial nephrectomy can safely and effectively treat T_(1b)RCC,with relatively good postoperative renal function and improved patients’quality of life,and may be selectively prioritized.