腹腔镜下根治性肾切除术治疗肾细胞癌疗效、安全性及术后复发危险因素分析

Efficacy, safety and analysis of risk factors of postoperative recurrence of retroperitoneal laparoscopic radical nephrectomy in the treatment of renal cell carcinoma

目的 探讨腹腔镜下根治性肾切除术治疗肾细胞癌的疗效、安全性及影响术后复发危险因素。方法 我院收治的125例肾癌患者,根据手术方案不同分为对照组61例(开放性根治性肾切除术)和观察组64例(腹腔镜下根治性肾切除术)。观察两组围手术期相关指标、安全性,随访3年,记录两组总生存率、术后复发率,分析影响患者术后复发的相关危险因素。结果 两组手术时间比较差异无统计学意义(P>0.05);观察组术中出血量少于对照组,术后进食时间、下床活动时间短于对照组(P<0.05)。观察组术后3年总生存率高于对照组,术后复发率及并发症总发生率低于对照组(P<0.05)。年龄≥65岁、有血尿、吸烟、术后病理分期(Ⅳ期)、出现淋巴结转移、开放性根治性肾切除术患者术后复发均更高(P<0.05)。年龄≥65岁、血尿、吸烟、术后病理分期(Ⅳ期)、淋巴结转移、手术方案为开放性根治性肾切除术是导致肾癌患者术后复发的危险因素(P<0.05)。结论 腹腔镜下根治性肾切除术治疗肾癌,可提高患者远期生存率;临床需针对引发患者术后复发的危险因素进行干预,以降低复发率,促进改善预后。

Objective To investigate the efficacy and safety of retroperitoneal laparoscopic radical nephrectomy in the treatment of renal cell carcinoma as well as the risk factors for postoperative recurrence.Methods One hundred and twenty-five patients with renal cancer treated in our hospital were selected. According to different surgical plans, the patients were divided into a control group(n=61 treated with open radical nephrectomy surgery) and an observation group(n=64 treated with laparoscopic radial nephrectomy surgery). The perioperative indicators and safety of the two groups were observed. The patients were followed up for 3 years. The overall survival rate and postoperative recurrence rate of the two groups were recorded, and the relevant risk factors affecting the postoperative recurrence were analyzed.Results There was no statistically significant difference in the operation time between the two groups(P>0.05). The intraoperative blood loss was less, and the postoperative eating time and the time of getting out of bed after surgery in the observation group were shorter than those of the control group(P<0.05). The 3-year overall survival rate was higher, the postoperative recurrence rate was lower and the total incidence of complications was lower in the observation group than those in the control group(P<0.05). Patients with age > 65 years old, hematuria, smoking, postoperative pathological stage(stage IV), lymph node metastasis, and open radical nephrectomy had higher postoperative recurrence rate(P<0.05). Above factors were also the risk factors for postoperative recurrence in patients with renal cancer.(P<0.05).Conclusion Laparoscopic radical nephrectomy for the treatment of renal cell carcinoma can improve the long-term survival rate of the patients. In order to reduce the recurrence rate and improve the prognosis, it is necessary to intervene in the risk factors of postoperative recurrence.