临床早期肾癌治疗中保留肾单位术应用的可行性以及有效性分析

Analysis of Effectiveness and Feasibility of Laparoscopic Nephron-sparing Surgery for Patients with Early Kidney Cancer

目的观察并探讨腹腔镜下保留肾单位术(LNSS)对早期肾癌治疗的有效性及安全性。方法选择2008年6月至2011年5月在梅州市人民医院接受手术治疗的早期肾癌患者92例,采用随机数字表法分为观察组和对照组,各46例。对照组接受腹腔镜根治性肾切除术(LRN),观察组接受LNSS。比较两组患者术中和手术前后血清肌酐水平及远期疗效。结果观察组手术时间、术中出血量和住院时间分别为(103±29)min、(157±56)m L和(11.5±2.3)d,对照组分别为(81±24)min、(76±26)m L和(8.9±3.1)d,两组比较差异有统计学意义(P<0.01)。两组患者术前、术后当日、6个月和12个月的血清肌酐比较差异无统计学意义(P>0.05)。观察组术后3年无瘤生存率和5年无瘤生存率分别为97.8%(45/46)和93.5%(43/46),对照组分别为95.7%(44/46)和91.3%(42/46),差异无统计学意义(P>0.05)。结论 LNSS与LRN治疗早期肾癌的远期疗效相当,但由于LNSS保留了患者肾功能,是临床上治疗早期肾癌的较佳选择之一。

Objective To observe and explore the effectiveness and feasibility of laparoscopic nephron-sparing surgery （LNSS） for patients with early kidney cancer.Methods 92 patients with early kidney cancer admitted to the People′s Hospital of Meizhou City from June 2008 to May 2011 were randomly divided into observation group and control group,46 cases in each group.The control group accepted laparoscopic radical nephrectomy （LRN）,while the observation group received LNSS.Surgical indicators as well as creatinine levels before and after surgery in two groups were recorded.Results Operative time,blood loss and length of hospital stay in the observation group were （103 ±29） min,（157 ±56） mL and （11.5 ±2.3） d,and were （81 ±24） min,（76 ±26） mL and （8.9 ±3.1） d in the control group,the difference was statistically signif-icant（P〈0.05）.The difference of serum creatinine level preoperative and postoperative day,6-month and 12-month between the two groups was not statistically significant（P〉0.05）.The 3-year disease-free survival and 5-year survival rates in the observation group were 97.8%（45/46） and 93.5%（43/46）,were 95.7%（44/46） and 91.3% （42/46） for the control group,the difference was not statistically significance（P 〉0.05 ） .Conclusion Long term effects of LNSS and LRN in the treatment of very early stage renal cell carci-noma,but LNSS is one of the better choice for the clinical treatment of early renal cell carcinoma because of it retains the renal function for patients.