经后腹腔入路腹腔镜下肾部分切除术治疗早期小肾癌患者的效果

Effects of laparoscopic partial nephrectomy via retroperitoneal approach in treatment of patients with early small renal cell carcinoma

目的:观察经后腹腔入路腹腔镜下肾部分切除术治疗早期小肾癌患者的效果。方法:选取2018年4月至2022年2月该院收治的85例早期小肾癌患者进行前瞻性研究,按照随机数字表法分为对照组(n=41)和观察组(n=44)。对照组采用经腹入路腹腔镜下肾部分切除术治疗,观察组采用经后腹腔入路腹腔镜下肾部分切除术治疗,比较两组术后病理组织特征、手术相关指标水平、术后并发症发生率、T细胞亚群指标(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))水平、血清学指标[C反应蛋白(CRP)、皮质醇、白细胞计数(WBC)]水平。结果:两组手术切缘均无阳性,两组术后病理组织学G分级情况比较,差异无统计学意义(P>0.05);两组肾动脉阻断时间、术中失血量比较,差异均无统计学意义(P>0.05);观察组手术时间、术后进食恢复时间、住院时间均短于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为9.09%(4/44),与对照组的7.32%(3/41)比较,差异无统计学意义(P>0.05);术后1 d,两组CD3^(+)、CD4^(+)/CD8^(+)、CD4^(+)水平均低于术前,但观察组高于对照组,差异有统计学意义(P<0.05);术后1 d,两组皮质醇、CRP、WBC水平均高于术前,但观察组低于对照组,差异有统计学意义(P<0.05)。结论:经后腹腔入路腹腔镜下肾部分切除术治疗早期小肾癌患者可改善手术相关指标水平,提高T细胞亚群指标水平,降低血清学指标水平,优于经腹入路腹腔镜下肾部分切除术治疗效果。

Objective:To observe effects of laparoscopic partial nephrectomy via retroperitoneal approach in treatment of patients with early small renal cell carcinoma.Methods:A prospective study was conducted on 85 patients with early small renal cell carcinoma admitted to the hospital from April 2018 to February 2022.They were divided into control group(n=41)and observation group(n=44)according to the random number table method.The control group was treated with laparoscopic partial nephrectomy via abdominal approach,while the observation group was treated with laparoscopic partial nephrectomy via retroperitoneal approach.The postoperative pathological tissue characteristics,the operation-related indicator levels,the incidence of postoperative complications,the T cell subsets(CD3^(+),CD4^(+),CD4^(+)/CD8^(+))levels,the serological indicator levels[C-reactive protein(CRP),cortisol,white blood cell count(WBC)]were compared between the two groups.Results:There were no positive surgical margins in both groups,and there was no significant difference in the postoperative histopathological G grading between the two groups(P>0.05).There were no significant differences in renal artery occlusion time and intraoperative blood loss between the two groups(P>0.05).The operation time,the postoperative feeding recovery time and the hospitalization time of the observation group were shorter than those of the control group,and the differences were statistically significant(P<0.05).The incidence of complications in the observation group was 9.09%(4/44),compared with 7.32%(3/41)in the control group,the difference was not statistically significant(P>0.05).1 day after the surgery,the levels of CD3^(+),CD4^(+)/CD8^(+)and CD4^(+)in the two groups were lower than those before the surgery,but those in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).Further,1 day after the surgery,the levels of cortisol,CRP and WBC in the two groups were higher than those before the surgery,but those in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusions:The laparoscopic partial nephrectomy via retroperitoneal approach in treatment of the patients with early small renal cell carcinoma can improve the levels of operation-related indicators,improve the levels of T cell subsets,and reduce the levels of serological indicators.Moreover,it is superior to laparoscopic partial nephrectomy via abdominal approach.