术前肾动脉栓塞治疗对肿瘤最大径≥10cm的肾细胞癌患者手术安全性的影响

The impact to operation safety of preoperative renal artery embolization for management of diameter ≥10 cm renal cell carcinoma

目的 探讨术前肾动脉栓塞治疗对肿瘤最大径≥10 cm的肾细胞癌患者手术安全性的影响.方法 回顾性分析2002年1月至2014年12月于北京大学第一医院泌尿外科行手术治疗的肿瘤最大径≥10 cm的肾细胞癌患者239例,根据术前是否行肾动脉栓塞治疗分为治疗组（53例）和对照组（186例）.比较两组患者的手术时间、输血量、住院时间、手术并发症情况.定量资料组间比较采用秩和检验,分类资料组间比较采用x2检验或Fisher精确概率检验.结果 除肿瘤位置（左侧/右侧）外,治疗组与对照组临床资料的差异无统计学意义（P＞0.05）.手术结果方面,治疗组开放手术比例高于对照组（96.2％比82.3％,x2=6.438,P=0.013）.两组手术时间[M（QR）,238（525） min比208（583） min,Z=-2.182,P=0.062]、输血（自体血及异体血）比例（26.4％比32.3％,x2=8.239,P=0.318）差异均无统计学意义,治疗组输血量低于对照组[700（1 900） ml比925（8 800） ml,Z=-1.064,P=0.006].治疗组的住院时间短于对照组[21（50）d比15（79）d,Z=-4.322,P=0.000],入住ICU患者比例高于对照组（54.7％比34.4％,x2=6.103,P=0.027）,而并发症发生率差异无统计学意义（0比3.2％,P=0.408）.结论 术前肾动脉栓塞治疗可以增加大体积肾肿瘤手术的安全性,并降低围手术期死亡的风险.

Objective To study the impact to operation safety of preoperative renal artery embolization for management of ≥ 10 cm renal cell carcinoma.Methods The clinical data of 239 cases with ≥ 10 cm renal cell carcinoma which all had underwent operation in Department of Urology,Peking University First Hospital from January 2002 to December 2014 were retrospectively analyzed.Fifty-three patients underwent preoperative renal artery embolization （therapeutic group） and 186 patients did not （control group）.The effect of embolization on operative time,transfusion requirements,hospitalization,ICU stay and perioperative complications were analyzed by comparing the two groups using rank sum test and x2 test or Fisher exact test.Results Comparing the therapeutic group and control group,there was significant difference in tumor location （on the left or right）.The mean age,sex,mean primary tumor size,and TNM stage were similar in both groups.Comparing the therapeutic group and control group,there were more open surgeries in therapeutic group （96.2% vs.82.3%,x2 =6.438,P=0.013）.There were no significant differences in mean operative time （238 （525） minutes vs.208 （583） minutes,Z =-2.182,P=0.062）.The mean blood transfusion （700 （1 900） ml vs.925 （8 800） ml,Z=-1.064,P=0.006）had significant difference.The therapeutic group had a longer mean hospitalization （21 （50） days vs.15 （79） days,Z=-4.322,P=0.000） and higher rate of intensive care unit stay （54.7% vs.34.4%,x2=6.103,P =0.027）.There was no significant difference in perioperative complications between two groups （0 vs.3.2%,P =0.408）.Conclusion Preoperative renal artery embolization in ≥ 10 cm renal cell carcinoma patients undergoing operation provides benefit in increasing operation safety and reducing perioperative death.