不同术式对局限性肾癌患者生命质量的影响

The Effect of Different Surgical Procedures on the Quality of Life in Patients with Localized Renal Cell Carcinoma

目的:调查不同术式对局限性肾癌患者生命质量的影响。方法:回顾性分析2010年1月-2015年12月在本院收治的局限性肾癌患者218例的临床资料,根据术式不同将患者分为腹腔镜保留肾单位组(n=54)、腹腔镜根治术组(n=55)、开放性保留肾单位组(n=55)、开放性根治术组(n=54),比较四组患者的生命质量、复发率与死亡率。结果:四组患者的躯体功能评分比较,差异均有统计学意义(P<0.01);两组之间互相比较,差异也均有统计学意义(P<0.05),其中腹腔镜保留肾单位组的躯体功能各项评分均最低。四组患者的心理功能评分比较,差异均有统计学意义(P<0.01);四组患者的社会功能中的工作、家庭、社会支持评分比较,差异均有统计学意义(P<0.01);四组患者的经济状况评分比较,差异均无统计学意义(P>0.05);腹腔镜根治术组与开放性保留肾单位组的心理、社会功能评分比较,差异均无统计学意义(P>0.05);其他各项指标除经济状况外,两组之间互相比较,差异均有统计学意义(P<0.05);其中腹腔镜保留肾单位组的心理、社会功能各项评分均最高。四组患者的复发率比较,差异有统计学意义(P=0.01),四组患者的死亡率比较,差异无统计学意义(P>0.05),其中腹腔镜保留肾单位组的复发率和死亡率均最低。结论:腹腔镜保留肾单位手术既切除了肾癌,又保留了肾单位,提高了术后患者的生命质量,降低了死亡率,是局限性肾癌目前比较理想的手术方法。

Objective：To investigate the effect of different surgical procedures on the quality of life in patients with localized renal cell carcinoma.Method：The clinical data of 218 patients with localized renal cell carcinoma from in our hospital January 2010 to December 2015 were analyzed retrospectively,depending on the mode of operation,the patients were divided into laparoscopic nephron sparing surgery group（n=54）,laparoscopic radical surgery group（n=55）,open nephron sparing surgery group（n=55）,and open radical surgery group（n=54）,the quality of life,recurrence rate and mortality were compared between the four groups.Result：The scores of physical function in the four groups were compared,the differences were statistically significant（P〈0.01）;between the two groups were compared,the differences were statistically significant（P〈0.05）;physical function scores of the laparoscopic nephron sparing surgery group were the lowest.Comparison of the psychological function of the scores of four groups,the differences were statistically significant（P〈0.01）;the four groups of social function in work,family,social support scores were compared,the differences were statistically significant（P〈0.01）;comparing the scores of the four groups of economic conditions,there were no significant differences（P〉0.05）;comparison of psychological and social function scores between laparoscopic radical surgery group and open nephron sparing surgery group,there were no statistically significant differences（P〉0.05）;in addition to the economic conditions,the two groups were compared with each other,the differences were statistically significant（P〉0.05）;the scores of psychological and social functions of the laparoscopic nephron sparing group were the highest.The recurrence rate of the four groups was statistically significant（P=0.01）,and there was no significant difference in the mortality between the four groups（P〈0.05）,the rates of recurrence and mortality in the laparoscopic nephron sparing group were the lowest.Conclusion：Laparoscopic nephron nephrectomy has removed the kidney cancer,but also retains the nephrons,improve the quality of life of patients after surgery,reduce the mortality rate,which is currently the ideal surgical method for localized renal cell carcinoma.