后腹腔镜下保留肾单位手术与根治性肾切除术治疗T1b期肾肿瘤的疗效比较

Comparison of curative effect between retroperitoneal laparoscopic nephron-sparing surgery and radical nephrectomy in the treatment of stage T1b renal carcinoma

目的:比较后腹腔镜下保留肾单位手术(NSS)与根治性肾切除术(RN)治疗T1b期肾肿瘤的近远期疗效。方法:选取T1b期肾肿瘤病人60例,均行后腹腔镜手术,按照手术方式分NSS组30例和RN组30例。比较2组病人手术时间、术中出血量和术后引流管留置时间、禁食时间、住院时间;术后随访2年,比较2组病人术前及术后24 h、1年、2年的血清肌酐(Scr)、尿素氮(BUN)水平,并比较2组术后1年、2年的生存率。结果:2组病人术后24 h的BUN和Scr水平均较术前明显升高(P<0.01),而2组间差异均无统计学意义(P>0.05);术后1年、2年,NSS组Scr、BUN水平均明显低于RN组(P<0.01)。2组病人手术时间、术中出血量和术后禁食时间、引流管留置时间、住院时间差异均无统计学意义(P>0.05)。2组病人1年、2年生存率差异均无统计学意义(P>0.05)。结论:NSS与RN疗效相近,NSS对T1b期肾肿瘤病人远期肾功能的影响更小,能更好地保护病人肾功能。

Objective： To compare the short and long-term effects between retroperitoneal laparoscopic nephron-sparing surgery（ NSS）and radical nephrectomy（ RN） in the treatment of stage T1 b renal carcinoma. Methods： Sixty stage T1 b renal carcinoma patients treated with retroperitoneal laparoscopic surgery were divided into the NSS group（ 30 cases） and RN group（ 30 cases） according to the method of surgery. The operation time,peroperative bleeding,postoperative drainage time,fast time and hospital stay between two groups were compared. All patients were followed up for 2 years. The serum levels of Scr and BUN between two groups before operation and after24 h,1 year and 2 years of operation were compared,and the 1-and 2-year survival rate between two groups were compared. Results：Compared with before operation,the serum levels of BUN and Scr in two groups after operation significantly increased（ P 〈0. 01）,and the difference of which between two groups was not statistically significant（ P 〉0. 05）. The serum levels of Scr and BUN in NSS group after 1 year and 2 years of operation were significantly lower than those in RN group（ P〈 0. 01）. The differences of the operation time,peroperative bleeding,postoperative drainage time,fast time and hospital stay between two groups were not statistically significant（ P 〉0. 05）. The differences of the 1-and 2-year survival rate between two groups were not statistically significant（ P 〉0. 05）. Conclusions：The curative effect of NSS is similar to the RN. The influence of NSS on the long-term renal function is less,which can effectively protect renal function.