不同保留肾单位术式治疗局限性肾癌临床效果的对比研究

The comparative study on clinical effects of different nephron-sparing surgical methods for localized renal carcinoma

目的:对比经腹腹腔镜、腹膜后腹腔镜和开放手术3种保留肾单位手术方式治疗局限性肾癌的临床效果。方法:回顾分析67例局限性肾癌患者的临床资料。根据术式分为3组,A组为经腹腹腔镜保留肾单位肿瘤切除组(22例);B组为腹膜后腹腔镜手术组(21例);C组为开放手术组(24例)。对比3组患者手术时间、肾脏热缺血时间、术中出血量、住院时间、术后复发、转移情况,并进行统计学分析。结果:所有手术均获成功,病理检查示透明细胞癌63例,颗粒细胞癌4例,均位于肾包膜内,切缘均阴性。3组手术时间分别为(118.7±27.9)min、(110.8±26.5)min、(106.4±25.5)min,差异无统计学意义(P>0.05)。肾脏热缺血时间分别为(24.2±13.1)min、(23.6±12.9)min、(14.2±4.5)min;术中出血量分别为(125.4±42.0)ml、(116.5±37.3)ml、(254.6±128.5)ml;住院时间分别为(11.2±3.0)d、(10.1±1.8)d、(16.2±3.2)d。以上3项C组与A、B组相比,差异有统计学意义(P<0.05),A、B两组相比差异无统计学意义(P>0.05)。术后随访8～60个月,B组局部复发1例,C组单发肺转移1例,均再次手术治愈;3组相比差异无统计学意义(P>0.0167)。结论:经腹腔及腹膜后径路行腹腔镜保留肾单位手术治疗局限性肾癌患者创伤小、康复快,临床效果与开放手术相当,可替代开放手术。

Objective：To compare the clinical effect of three different nephron-sparing surgical methods including peritoneal laparoseopy, retroperitoneal laparoscopy and open surgery for localized renal carcinoma. Methods ： The clinical data of 67 patients with localized renal carcinoma was retrospectively analyzed. According to the methods of operation, they were divided into three groups, group A： 22 patients underwent peritoneal laparoscopic excision, group B： 21 patients underwent retroperitoneal laparoscopic excision and group C： 24 patients underwent open surgery. The operating time, renal warm isehemia time, blood loss,hospital stay, postoperative recurrence and metastasis were compared among the three groups and were statistically analyzed. Results： All of the operations were successful. 63 specimens were proved clear cell carcinoma and 4 specimens were proved granular cell carcinoma by pathology examination. All of them were in renal capsule and the margin tissues were negative. The operation time of group A, group B and group C were （118.7±27.9） rain, （110.8±26.5 ） min and （106.4±25.5 ） min respectively. There was no statistically significant difference in them （ P 〉 0.05 ）. Renal warm ischemia time were （24.2±13.1 ） rain, （23.6±12.9 ） rain and （ 14.2±4.5 ） min respectively. The volumes of blood loss were （ 125.4±42.0 ） ml, （ 116.5±37.3 ） ml and （254.6±128.5 ） ml respectively. The time of hospital stay were （ 11.2±3.0） d, （ 10.1±1.8 ） d and （ 16.2±3.2） d respectively. There was statistically significant difference in group C vs group A and group B in tile three terms above （ P 〈 0.05 ） and there was no statistically significant difference between group A and group B （ P 〉 0.05 ）. All of the patients were followed up 8 to 60 months, l ease of tumor local recurrence in group B and 1 ease of soli- tary pulmonary metastasis in group C were found. They were cured by re-operation. There was no statistically significant difference among the three groups （ P 〉 0.0167 ）. Conclusions ： Peritoneal laparoscopie and retroperitoneal laparoscopic nephron-sparing surgery for localized renal carcinoma have the advantages of minimal invasion, quick recovery and equal clinical effect with open surgery, and can substitute for open surgery.