腹膜后肾肿瘤切除术与经腹肾肿瘤切除术治疗儿童双侧肾母细胞瘤的疗效比较

Comparison of retroperitoneal nephrectomy and transabdominal nephrectomy in the treatment of bilateral Wilms tumor in children

目的比较腹膜后肾肿瘤切除术与经腹肾肿瘤切除术治疗儿童双侧肾母细胞瘤(bilateral Wilms tumor,BWT)的临床疗效。方法选取1999年1月至2016年10月于本院采取手术治疗且经病理活检确诊为BWT的48例患儿为研究对象,按照实际治疗方案将其分为研究组(经腹膜后肾肿瘤切除术,16例)和对照组(经腹肾肿瘤切除术,32例),比较两组患儿的手术情况(手术时间、术中出血量、不良事件发生情况)、术后情况(住ICU天数、住院天数、肾功能恢复时间、血肌酐水平、并发症发生情况)、术后生存时间及生存结局。结果研究组患儿的手术时间、住ICU天数、住院天数均显著短于对照组(P_均<0.05);两组患儿的术中出血量、术中不良事件发生率、血肌酐水平、肾功能恢复时间、并发症发生率比较均无显著差异(P_均>0.05)。48例患儿中32例完成全部治疗,10例带瘤生存,2年生存率为68.2%。研究组患儿的中位生存时间为27.8个月(95%CI:22.8～33.1个月);对照组患儿为22.7个月(95%CI:14.2～31.8个月),两组患儿生存结局无显著差异(P> 0.05)。结论相较于经腹肾肿瘤切除术,经腹膜后肾肿瘤切除术治疗儿童BWT,可缩短手术时间、住ICU天数及术后住院天数,使患儿尽早恢复肾功能,是治疗儿童BWT的可行手术方式。

Objective To investigate the clinical efficacy of retroperitoneal nephrectomy and transabdominal nephrectomy in the treatment of bilateral Wilms tumor(BWT)in children.Method From January 1999 to October 2016,48 children with BWT diagnosed by pathological biopsy who underwent surgical treatment in our hospital were selected as the subjects of the study.According to the actual treatment plan,they were divided into study group(retroperitoneal nephrectomy,n=16)and control group(transabdominal nephrectomy,n=32).The operative conditions(operation time,intraoperative blood loss,adverse events),postoperative condition(ICU day,hospital day,time of recovery of renal function,level of serum creatinine,occurrence of complications),survival time and outcome after operation were compared between the two groups.Result The operation time,ICU days and hospital days in study group were significantly shorter than those in control group(Pall<0.05).There were no significant differences in intraoperative blood loss,incidence of intraoperative adverse events,serum creatinine level,recovery time of renal function and incidence of complications between the two groups(Pall>0.05).In 48 children,32 cases completed all the treatment,10 cases survived with tumor,and the 2-year survival rate was 68.2%.The median survival time was 27.8 months(95%CI:22.8 ~ 33.1 months)in study group and 22.7 months(95%CI:14.2 ~ 31.8 months)in control group.There was no significant difference in survival outcomes between the two groups(P>0.05).Conclusion Compared with transabdominal nephrectomy,retroperitoneal nephrectomy in the treatment of BWT,can shorten the operation time,ICU days and hospital days,and restore normal renal function as soon as possible.It is a feasible surgical method for the treatment of children with BWT.