腹腔镜肾动脉阻断肾部分切除术与根治性肾切除术在T_(1)期肾癌治疗中的安全性分析

Analysis on safety of laparoscopic renal artery occlusion partial nephrectomy and radical nephrectomy in treatment of T_(1) stage renal carcinoma

目的分析腹腔镜肾动脉阻断肾部分切除术(LPN)与根治性肾切除术(LRN)在T_(1)期肾癌治疗中的安全性。方法选取2018年6月至2021年6月于该院接受治疗的68例T_(1)期肾癌患者纳入研究,按照手术方式不同,将其分为LPN组(33例)和LRN组(35例),比较两组手术相关指标、术后肾功能指标、并发症及随访1年患者病死率。结果与LRN组比较,LPN组患者术中出血量较多、手术时间较长、术后进食时间较晚,差异均有统计学意义(P<0.05)。与术前比较,两组术后肾小球滤过率(eGFR)均降低,血清肌酐(SCr)水平均升高,差异均有统计学意义(P<0.05)。与LRN组比较,LPN组患者术后eGFR较高,SCr水平较低,差异均有统计学意义(P<0.05);两组术后并发症总发生率比较差异无统计学意义(P>0.05)。术后随访1年,LPN组中无患者死亡,LRN组中有1例死亡,两组术后1年病死率比较差异无统计学意义(P>0.05)。结论LPN和LRN治疗T_(1)期肾癌安全、有效,与LRN相比,LPN可有效保留肾功能,临床应根据患者肿瘤状态及机体条件选择合适的术式。

Objective To analyze the safety of laparoscopic partial nephrectomy(LPN) by renal artery occlusion and laparoscopic radical nephrectomy(LRN) in the treatment of T_(1)stage renal cancer.Methods A total of 68 patients with T_(1)stage renal cancer receiving the treatment in this hospital from June 2018 to June 2021 were selected and included in the study.According to different surgical methods,they were divided into the LPN group(33 cases) and LRN group(35 cases).The changes of surgery-related indicators,postoperative renal function indicators,postoperative complications and mortality rate after 1-year follow up were compared between the two groups.Results Compared with the LRN group,the LPN group had more intraoperative blood loss,longer operation time,later postoperative eating time,and the differences were statistically significant(P<0.05).Compared with before operation,postoperative glomerular filtration rate(eGFR) in both groups was decreased,serum creatinine(SCr) was increased,and the differences were statistically significant(P<0.05).Compared with the LRN group,postoperative eGFR in the LPN group was higher,and serum Scr was lower,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the occurrence rate of postoperative complications between the two groups(P>0.05).The postoperative followed up lasted for one year,in the LPN group,there was no case of death,and there was 1 case of death in the LRN group,the postoperative 1 year mortality rate had no statistical difference between the two groups(P>0.05).Conclusion LPN and LRN are safe and effective in the treatment of T_(1)stage renal cancer.Compared with LRN,LPN could effectively preserve the renal function.The appropriate surgical method should be selected according to the patient′s tumor status and body conditions.