肿瘤内侵程度对肾部分切除术围手术期的影响

Effect of tumor endophytic extent on perioperative outcome of partial nephrectomy

目的:探讨肿瘤内侵程度对肾部分切除术的围手术期的影响,评估肾部分切除术对早期肾癌的远期治疗效果。方法:收集2011年1月至2013年12月于天津医科大学肿瘤医院接受行肾部分切除术的T1N0M0肾癌患者157例,以肿瘤边缘与集合系统或肾窦脂肪距离<1 cm与≥1 cm分组。统计两组围手术期结果及病理类型,记录术后并发症并进行随访。结果:患者性别、年龄、肿瘤大小、肿瘤是否累犯中极、出血量、术后住院时间、肿瘤病理类型在组间差异无统计学意义(P>0.05)。肿瘤边缘与集合系统的距离<1 cm组的患者术中的热缺血时间与手术时间较长,均差异具有统计学意义(P=0.001与P=0.033)。术后并发症10例。术后中位随访18个月,均未见肿瘤复发或转移。结论:肿瘤边缘与集合系统的距离反映肾部分切除术的复杂程度,并与手术热缺血时间、手术时间相关,肾部分切除术治疗T1M0N0肾癌并发症发生率低、复发或转移率低,安全有效。

Objective：To analyze the impact of endophytic extent of renal tumor on the perioperative outcomes after partial ne-phrectomy and evaluate the long-term therapeutic effect of early renal cancer. Methods：A retrospective review was performed for 157 patients who underwent partial nephrectomy of T1N0M0 kidney cancer in Tianjin Medical University Cancer Institute and Hospital be-tween January 2011 and December 2013. The patients were classified into two groups according to the distance of the tumor margin to the collective system or renal sinus fat：group A,〈1 cm;and group B,≥1 cm. The perioperative outcomes and pathologic types in the two groups were summarized and analyzed. The postoperative complications were recorded and followed up. Results：No statistically significant differences were found in the patients＇ gender, age, tumor size, recidivist status of Chung Chi, estimated blood loss, postoper-ative hospitalization time, and pathological types between the two groups （P〉0.05）. The warm ischemia time and operation time were significantly longer in group A than in group B （P=0.001;P=0.033）. Postoperative complications occurred in 10 patients. No local tu-mor recurrence or metastasis was observed in the patients during a median follow-up of 18 months. Conclusion：The distance between the tumor margin and the collective system reflects the complexity of partial nephrectomy, which is associated with the warm ischemia time and operation time. Partial nephrectomy is safe and effective. This procedure has low complications and good survival.