腹腔镜下两种术式治疗T2N0M0期肾癌的临床疗效分析

Clinical analysis of two laparoscopic procedures in the treatment of T2N0M0 renal cell carcinoma

目的比较腹腔镜下肾部分切除术(LPN)与腹腔镜下根治性肾切除术(LRN)在T2N0M0期肾癌中的临床疗效及安全性。方法回顾性分析2010年1月至2018年12月该院收治的T2期肾癌患者临床资料,以TNM分期标准分为T2a期和T2b期,再根据手术方式将T2a期分为LPNa组(n=214)和LRNa组(n=105),T2b期分为LPNb组(n=29)和LRNb组(n=61),比较不同术式下患者的一般临床资料、肿瘤特征、手术相关指标、切缘阳性、二次手术、术后复发、肾功能变化等指标。结果LPNa组和LPNb组R.E.N.A.L评分分别较LRNa组和LRNb组低,估计失血量、术后住院时间、术后血红蛋白(Hb)下降水平、术后6个月估计肾小球滤过率(eGFR)水平分别较LRNa组和LRNb组高,差异有统计学意义(P<0.05)。LPNa组平均热缺血时间为(28.15±12.30)min,LPNb组为(38.60±17.00)min。与LRNb组比较,LPNb组手术时间更长,二次手术率更高,差异有统计学意义(P<0.05)。结论LPN对T2a肾癌患者安全有效,而对T2b肾癌术后保护肾功能更有优势。

Objective To compare the clinical efficacy and safety of the laparoscopic partial nephrectomy(LPN)and laparoscopic radical nephrectomy(LRN)in T2N0M0 renal cell carcinoma.Methods The clinical data of the patients with T2 renal cell carcinoma treated in this hospital from January 2010 to December 2018 were retrospectively analyzed.The patients were divided into the T2a group and the T2b group according to the TNM staging standard.According to the operation method,the T2a group was divided into the LPNa group(n=214)and the LRNa group(n=105),the T2b group was divided into the LPNb group(n=29)and the LRNb group(n=61).The general clinical data,tumor features,peri-operative related factors,positive margin,secondary operation,postoperative recurrence and renal function recovery of the two groups were compared.Results The R.E.N.A.L score in the LPNa group and the LPNb group were significantly lower than those in the LRNa group and the LRNb group,while estimated blood loss,postoperative hospital stay,postoperative hemoglobin(Hb)decrease and estimated glomerular filtration rate(eGFR)level at 6 months after operation in the LPNa group and the LPNb group were significantly higher than those in the LRNa group and the LRNb group(P<0.05).The mean warm ischemia time in the LPNa group was(28.15±12.30)min,that of the LPNb group was(38.60±17.00)min.Compared with those of the LRNb group,the operation time of the LPNb group was longer and the second operation rate was higher,and the differences were statistically significant(P<0.05).Conclusion LPN is safe and effective in the patients with T2a renal cell carcinoma,but it has more advantages in protecting renal function after operation of T2b renal cell carcinoma.