后腹腔镜肾部分切除术治疗肾门肿瘤与非肾门肿瘤(≤7cm)的对比性分析

Analysis of retroperitoneal laparoscopic partial nephrectomy for hilar and nonhilar tumors≤7 cm

目的评估后腹腔镜肾部分切除术治疗肾门肿瘤的有效性及安全性。方法 2013年5月至2017年3月,共有168例≤7cm肾肿瘤患者在本中心接受后腹腔镜肾部分切除术治疗,分为肾门肿瘤组和非肾门肿瘤组,对比两组围手术期数据、并发症、肾功能、肿瘤复发及转移情况。结果肾门肿瘤组肿瘤直径(4.6 vs.3.6cm)及R.E.N.A.L.评分均高于非肾门肿瘤组(P<0.001),有显著统计学差异。肾门肿瘤组相较于非肾门肿瘤组,两组在手术时间、失血量、热缺血时间、术后住院时间、输血率、阳性切缘均无显著性差异(P>0.05)。两组术后3月eGFR较术前降低水平无差异[13.8mL/(min·1.73m^2)vs.11.3mL/(min·1.73m^2,)P=0.609]。两组并发症、局部复发及远处转移发生率无显著性差异(P>0.05)。结论后腹腔镜肾部分切除术治疗肾门肿瘤(≤7cm)是安全、有效的手术方式,手术风险、并发症及近期预后与非肾门肿瘤类似。

ObjectiveTo evaluate the effectiveness and safety of retroperitoneal laparoscopic partial nephrectomy （LPN） in the treatment of hilar tumors.MethodsA total of 168 patients with renal lesion≤7 cm undergoing retroperitoneal LPN from May 2013 to March 2017 were divided into hilar group and nonhilar group. The perioperative results,complications,renal function and oncologic outcomes of the two groups were analyzed. ResultsThe mean tumor size of hilar tumors was larger than that of nonhilar ones （4.6 cm vs. 3.6 cm,P〈0.001）. Hilar tumors had higher R.E.N.A.L score than nonhilar tumors （P〈0.001）. No differences were noted in operation time,blood loss,warm ischemia time,length of hospital stay,transfusion rate,positive margins,overall complications rate,recurrence and metastasis rates between the two groups （P〉0.05）. Postoperative estimated glomerular filtration rate （eGFR） 3 months after operation showed a decrease of 13.8 mL/（min·1.73 m2 ） and 11.3 mL/（min·1.73 m2） for hilar and nonhilar tumors（P=0.609）,respectively. Conclusion Retroperitoneal LPN is safe and effective in the treatment of hilar tumors,and has the same operation risk,complication rate and shortterm prognosis as in the treatment of nonhilar tumors≤7 cm.