热消融辅助腹腔镜肾肿瘤剜除术治疗早期肾肿瘤对患者术后肾功能和肿瘤控制效果的影响

Influence of thermal ablation-assisted laparoscopic renal tumor enucleation on postoperative renal function and tumor control effect in patients with early renal tumors

目的探讨热消融辅助腹腔镜肾肿瘤剜除术治疗早期肾肿瘤对患者术后肾功能和肿瘤控制效果的影响。方法回顾性分析2018年6月至2021年6月安康市中心医院收治的97例早期肾肿瘤患者的临床资料,将其中43例采用单纯腹腔镜肾部分切除术者纳入切除组,54例采用热消融辅助腹腔镜肾肿瘤剜除术者纳入消融组,比较两组患者的手术情况,以及术前、术后1周的肾功能和术后1周的并发症发生率,并比较两组患者术后6个月、9个月、12个月、18个月的肿瘤控制效果。结果消融组患者的手术时间、术后排尿时间、住院时间分别为(1.98±0.43)h、(32.79±9.23)h、(8.97±2.41)d,明显少于切除组的(2.24±0.55)h、(36.88±10.17)h、(9.96±2.34)d,差异均有统计学意义(P<0.05);术后1周,两组患者的血肌酐(Scr)水平较术前均明显升高,但消融组为(142.63±22.18)μmol/L,明显低于同期切除组的(156.27±31.25)μmol/L,差异均有统计学意义(P<0.05);术后1周,两组患者估算肾小球滤过率(eGFR)、胱抑素C(Cys C)水平较术前均明显降低,但消融组分别为(79.27±6.81)mL/min、(1.04±0.27)mg/L,明显高于同期切除组的(75.81±7.06)mL/min、(0.86±0.29)mg/L,差异均有统计学意义(P<0.05);术后1周,消融组患者的术后并发症发生率为20.37%,明显低于切除组的41.86%,差异有统计学意义(P<0.05);术后6个月、9个月、12个月、18个月,两组患者的肿瘤复发率比较差异均无统计学意义(P>0.05)。结论热消融辅助腹腔镜肾肿瘤剜除术与单纯腹腔镜肾部分切除术对早期肾肿瘤均有良好的肿瘤控制效果,其中热消融辅助腹腔镜肾肿瘤剜除术的手术时间、术后住院时间更短,患者术后肾功能损伤更小,术后并发症发生率更低。

Objective To explore the influence of thermal ablationassisted laparoscopic renal tumor enucleation on postoperative renal function and tumor control effect in the treatment of early renal tumors.Methods The clinical data of 97 patients with early renal tumors who were treated in Ankang Central Hospital were retrospectively analyzed between June 2018 and June 2021.Among the patients,43 cases treated with simple laparoscopic partial nephrectomy were included in resection group,and 54 cases treated with thermal ablationassisted laparoscopic renal tumor enucleation were enrolled as ablation group.The surgical conditions,and renal function before surgery and at 1 week after surgery,incidence of complications at 1 week after surgery,and tumor control effect within 6 months,9 months,12 months and 18 months after surgery were compared between the two groups.Results The surgical time,postoperative urination time,and length of hospital stay were(1.98±0.43)h,(32.79±9.23)h,and(8.97±2.41)d in ablation group,significantly shorter than(2.24±0.55)h,(36.88±10.17)h,and(9.96±2.34)d in resection group(P<0.05).At 1 week after surgery,the level of serum creatinine(Scr)in both groups was significantly enhanced compared with that before surgery,and the level in ablation group of(142.63±22.18)μmol/L was significantly lower than(156.27±31.25)μmol/L in resection group(P<0.05).The estimated glomerular filtration rate(eGFR)and cystatin C(Cys C)in both groups at 1 week after surgery were significantly decreased compared to before surgery,but the eGFR and Cys C in ablation group were(79.27±6.81)mL/min and(1.04±0.27)mg/L,significantly higher than(75.81±7.06)mL/min and(0.86±0.29)mg/L in resection group(P<0.05).At 1 week after surgery,the total incidence of postoperative complications in ablation group was 20.37%,which was significantly lower than 41.86%in resection group(P<0.05).At 6 months,9 months,12 months,and 18 months after surgery,there was no statistically significant difference in tumor recurrence rate between the two groups(P>0.05).Conclusion Both thermal ablationassisted laparoscopic renal tumor enucleation and simple laparoscopic partial nephrectomy have good tumor control effect on early renal tumors.However,the former has shorter surgical time and postoperative length of hospital stay,smaller postoperative renal function injury,and lower incidence of postoperative complications.