腹腔镜下保留肾单位手术与根治性肾切除术在局限性肾癌中的应用效果

Application effect of laparoscopic nephron-sparing surgery and radical nephrectomy in localized renal cancer

目的探讨腹腔镜下保留肾单位手术与根治性肾切除术在局限性肾癌中的应用效果。方法根据手术方式的不同将150例局限性肾癌患者分为对照组(n=75)和观察组(n=75),对照组患者采取腹腔镜下根治性肾切除术,观察组患者采取腹腔镜下保留肾单位手术。比较两组患者的手术相关指标、血清肌酐(Scr)水平、生活质量[欧洲癌症研究与治疗组织生命质量测定量表(EORTC QLQ-C30)]及并发症发生情况。结果观察组患者的术中出血量明显少于对照组,手术时间明显长于对照组,引流时间、术后禁食时间、术后住院时间均明显短于对照组,差异均有统计学意义(P<0.01)。术后24 h、术后3个月,两组患者的Scr水平均高于本组术前,观察组患者的Scr水平均低于对照组,差异均有统计学意义(P<0.05)。术后3个月,两组患者的躯体功能、情绪功能、社会功能、认知功能、角色功能评分均高于本组术前,观察组的患者躯体功能、情绪功能、社会功能、认知功能、角色功能评分均高于对照组,差异均有统计学意义(P<0.05)。两组患者的并发症总发生率比较,差异无统计学意义(P>0.05)。结论与腹腔镜下根治性肾切除术相比,腹腔镜下保留肾单位手术治疗局限性肾癌患者能够缩短住院时间,减少术中出血量,减轻对肾功能的影响,提高患者生活质量,且具有较高的安全性。

Objective To investigate the application effect of laparoscopic nephron-sparing surgery and radical nephrectomy in localized renal cancer.Method A total of 150 patients with localized renal cancer were divided into control group(n=75)and observation group(n=75)according to different surgical methods.The patients in the control group underwent laparoscopic radical nephrectomy,and the patients in the observation group underwent laparoscopic nephronsparing surgery.The surgery-related indicators,serum creatinine(Scr)levels,quality of life[European Organization for Research and Treatment of Cancer quality of life questionnaire core 30(EORTC QLQ-C30)],and complications between the two groups were compared.Result The intraoperative blood loss in the observation group was significantly less than that in the control group,the operation time was significantly longer than that in the control group,and the drainage time,postoperative fasting time,and postoperative hospital stay were significantly shorter than those in the control group,and the differences were statistically significant(P<0.01).At 24 h and 3 months after surgery,the Scr levels in the two groups were higher than those before surgery,and the Scr levels in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).Three months after surgery,the scores of physical function,emotional function,social function,cognitive function,and role function of the two groups were higher than those before surgery,and the above scores of the observation group were higher than those of the control group,and the difference were statistically significant(P<0.05).There was no significant difference in the total incidence of complications between the two groups(P>0.05).Conclusion Compared with laparoscopic radical nephrectomy,laparoscopic nephronsparing surgery for patients with localized renal cancer can shorten the hospital stay,reduce the volume of intraoperative blood loss,reduce the impact on renal function,improve the quality of life of patients with acceptable safety.