小切缘保肾手术治疗早期肾癌的安全性及有效性

Safety and efficacy of small margin nephron-sparing surgery treating early renal cell carcinoma

目的 比较不同切缘大小对保肾手术患者的远期临床效果,分析并探讨小切缘保肾手术治疗早期肾癌的安全性及有效性.方法 回顾性分析2009年7月～2014年7月于丽水市中心医院进行诊断为局限性肾癌（T1期）并接受开放性保留肾单位术患者100例的临床资料.按照测得的手术切缘厚度将100例患者分为两组,切缘≤4 cm组54例和切缘＞4 cm组46例,观察和比较两组手术时间、术中出血量、术后住院时间、引流时间、术后血肌酐、复发率和生存率等.结果 切缘≤4 cm组手术时间、术中出血量明显少于切缘＞4 cm组,差异有统计学意义（P＜0.05）.两组3、5年生存率（96.30％、92.60％比93.48％、86.96％）及复发率（1.85％、3.70％比4.34％、6.52％）比较,差异无统计学意义（P＞0.05）.结论 不同切缘大小的保肾手术的效果相当,但小切缘保肾手术的安全性高,手术难度低,并发症少,远期效果显著,为患者保留更多的功能性肾单位,是有效治疗早期肾癌的手术手段,值得在临床上推广使用.

Objective To compare long-term clinical effects the different cutting edge size on patients treated with nephron-sparing surgery,and analyze the safety and efficacy of small margin nephron-sparing surgery treating early renal cell carcinoma.Methods From July 2009 to July 2014,in Lishui Central Hospital,the data of 100 patients with local renal cell carcinoma （T1 period） and treated with neuronal-sparing surgery.According to cutting edge size gotten from the surgery,the patients were divided in to cutting edge ≤ 4 cm group （54 cases） and cutting edge ＞ 4 cm group （46 cases）,the operative time,intranperative blood loss,drainage time,postoperation hospitalization,postoperative serum creatinine,recurrence rate and survival rate and so on of two groups were observed and compared.Results The operative time,intranperative blood loss,drainage time in cutting edge ≤ 4 cm group were less than those in ＞ 4 cm group,the differences were statistically significant （P ＜ 0.05）.The 3,5 years survival rate （96.30％,92.60％ vs 93.48％,86.96％） and 3,5 years recurrence rate （1.85％,3.70％ vs 4.34％,6.52％） of two groups were compared,the differences were statistically significant （P ＜ 0.05）.Conclusion The effects of different cutting edge size neuronal-sparing surgery are similar,but small cutting edge size neuronal-sparing surgery is safer,lower surgical difficulty,less complications,better long-term effect,it can retain more functional renal units.It is effectively method treating early renal cell carcinoma,and worth popularizing in clinical use.