保留肾单位术在早期肾癌治疗中的临床价值

The clinical value of nephron- sparing surgery in early kidney cancer treatment

目的 探讨保留肾单位术在早期肾癌治疗中的临床价值.方法 选取2006年2月至2013年1月38例早期肾癌患者随机分为试验组18例和对照组20例.试验组予保留肾单位术,对照组予肾根治性切除术,将两组的手术时间、术中出血量、住院时间、术后并发症、肿瘤复发率等进行比较.结果 两组患者手术均成功.试验组1例患者术后4d有腰部切口漏尿,静脉肾盂造影排除泌尿系梗阻未见明显瘘口,术后两周患者自愈,并发症发生率为5.5％,对照组术后均未发生并发症（0％）.对两组患者术后随访3～5年,试验组3年内有1例（5.5％）肿瘤局部复发,对照组无局部复发例数,两组并发症与肿瘤复发率比较差异均无统计学意义.试验组的平均手术时间、平均出血量、住院时间与对照组比较差异无统计学意义,但有效的保留患肾近大部分肾组织及功能.结论 早期肾癌能够及时诊断、准确评估病情,选择保留肾单位术可以达到和肾根治性切除术相同的手术效果,同时保留了部分肾功能提高了患者生活质量,延长生存时间.

Objective To explore the clinical value of nephron - sparing surgery in early kidney cancer treatment. Methods Thirty - eight early renal carcinomapatients from February 2006 to January 2013 were collected and thenrandomly divided into the experimental group （18 cases） and the control group（ 20 cases）. The experi- mental group was given nephron -sparing surgeryand the control group was given the radical nephrectomy. The operation time, intraoperative blood loss, hospital stay, postoperative complications and tumor recurrence rate in two groups were compared. Results The operation in two groups were successful. One patient in experimental group had lumbar incision leakage after 4 days of operation with no obvious fistula seen via intravenous pyelogra- phy. Patients were recovered within tWO weeks after operation. The incidence of complications .in experimental group was 5.5 % while no postoperative complications were shown in the control group. Upon two groups of pa- tients in postoperative follow - up of 3 - 5 years, 1 case of tumor local recurrence in the experimental group was seen in 3 years and no local recurrence cases were indicated in the control group with no significant difference of complications and tumor recurrence rate seen between these two groups. In addition, nephron - sparing surgery preserved the most of the renal tissue and function in the damaged kidney. However, there was no significant difference of the average operation time, average blood loss and hospital stay between the expefimental gtoup and the control group. Conclusion Early kidney cancer could be timely diagnosed with the accurate assessment of disease. Nephronsparing surgery could achieve the same operation effects as.radical nephrectomy .and also preserve the renal function, which improves the patient life quality and prolongs the patient survival time.