腹腔镜下肾部分切除术对局限性肾癌患者术后康复及生活质量的影响

Effect of laparoscopic partial nephrectomy on postoperative rehabilitation and quality of life in patients with localized renal cancer

目的探讨腹腔镜下肾部分切除术(RLPN)对局限性肾癌(LRCC)患者术后康复及生活质量的影响。方法选取2014年1月至2019年1月间咸阳市中心医院收治的102例LRCC患者进行回顾性分析,根据治疗方案不同分组,采用开放性肾部分切除术(OPN)治疗的51例患者纳入对照组,采用RLPN治疗的51例患者纳入研究组。比较两组患者的手术情况、术后康复情况、术后并发症发生率、手术前后患侧肾脏肾小球滤过率(GFR)、血清肌酐(Cr)水平和生活质量。结果研究组患者术中出血量及术后引流量均少于对照组,手术时间、术后引流、下床活动、肠鸣音恢复及术后住院等时间均短于对照组,差异均有统计学意义(均P<0.05)。研究组患者术后并发症总发生率为3.9%,低于对照组的15.7%,差异有统计学意义(P<0.05)。术后1个月,两组患者患侧肾脏GFR均低于手术前,但研究组高于对照组,两组患者血清Cr水平均高于手术前,差异均有统计学意义(均P<0.05)。术后3个月,两组患者生活质量评分均高于手术前,且研究组高于对照组,差异均有统计学意义(均P<0.05)。结论采用RLPN治疗LRCC,能减少患者术中创伤,缩短手术时间,降低术后并发症发生率,促进术后恢复,且在保护患侧肾脏GFR方面有一定优势,能进一步改善患者术后生活质量。

Objective To study the effect of laparoscopic partial nephrectomy(RLPN)on postoperative rehabilitation and quality of life in patients with localized renal cell carcinoma(LRCC).Methods The clinical data of 102 patients with LRCC at Xianyang Central Hospital were retrospectively analyzed.According to the treatment plan,51 patients receiving open partial nephrectomy(OPN)were included in the control groupand 51 patients receiving RLPN were included in the study group.The operation status,postoperative rehabilitation,postoperative complication rate,glomerular filtration rate(GFR)on affected side,serum creatinine(Cr)level and quality of life were compared between the two groups.Results The intraoperative blood loss and postoperative drainage were lower in the study group than in the control group.The time of operation,postoperative drainage,time to out-of-bed activity,recovery of bowel sounds and postoperative hospitalization were shorter in the study group than in the control group(all P<0.05).The overall incidence of postoperative complications(3.9%)was lower in the group than in the control group(15.7%)(P<0.05).At one month after surgery,GFR rates on the affected side in the two groups were lower than before the operation,but the GFR rate was higher in the study group than in the control group(P<0.05).The serum Cr levels were higher in the two groups than before the operation(all P<0.05).The quality of life scores were higher in the two groups at 3 months after the operation than before the operation,and the score was higher in the study group than in the control group(all P<0.05).Conclusion RLPN can significantly reduce intraoperative trauma,shorten the operation time,reduce the incidence of postoperative complications,promote postoperative recovery,and have certain advantages in protecting GFR on the affected side,which can further improve postoperative quality od life in patients with LRCC.