腹腔镜肾部分切除术与根治性切除术治疗T2a期肾癌的效果比较

Effect comparison of laparoscopic partial nephrectomy and radical nephrectomy for T2a stage renal carcinoma

目的 比较腹腔镜肾部分切除术与根治性切除术对T2a期肾癌的效果及随访结局。方法 选取2018年3月至2021年3月许昌市中心医院收治的T2a期肾癌患者60例为研究对象。依据手术方式不同分为腹腔镜肾部分切除术(LPN)组与腹腔镜根治性肾切除术(LRN)组,每组30例。比较两组手术前后近期肾相关指标[血红蛋白(HGB)、血肌酐(Scr)水平及肾小球滤过率(eGFR)]、炎症因子[肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)及白细胞介素-6(IL-6)]、体液免疫[免疫球蛋白G(IgG)、免疫球蛋白M(IgM)、免疫球蛋白A(IgA)]、细胞免疫(CD4^(+)、CD8^(+)及CD4^(+)/CD8^(+))水平及生存情况。结果 术前,两组HGB、Scr水平及eGFR比较,差异未见统计学意义(P>0.05);术后1 d,两组HGB水平比较,差异未见统计学意义(P>0.05),LPN组Scr水平明显低于LRN组,eGFR水平明显高于LRN组,差异有统计学意义(P<0.05)。术前,两组TNF-α、CRP及IL-6水平比较,差异未见统计学意义(P>0.05);术后1 d, LPN组TNF-α、CRP及IL-6水平明显低于LRN组,差异有统计学意义(P<0.05)。术前,两组体液免疫及细胞免疫指标比较差异未见统计学意义(P>0.05);术后1 d, LPN组IgG、IgM、IgA、CD4^(+)、CD8^(+)及CD4^(+)/CD8^(+)水平明显高于LRN组,差异有统计学意义(P<0.05)。两组2年生存率比较,差异未见统计学意义(P>0.05)。结论 两种治疗方式均可改善患者预后,生存率无差异,但腹腔镜肾部分切除术可保留一部分肾功能,减轻炎症损伤,提升患者免疫力。

Objective To compare the efficacy and follow⁃up outcomes of laparoscopic partial nephrectomy and radical nephrectomy for stage T2a renal cell carcinoma.Methods Sixty patients with stage T2a renal carcinoma admitted to Xuchang Central Hospital from March 2018 to March 2021 were selected as the study objects.They were divided into laparoscopic partial nephrectomy(LPN)group and laparoscopic radical nephrectomy(LRN)group,with 30 cases in each group.The levels of kidney related indexes[hemoglobin(HGB),serum creatinine(Scr)levels and glomerular filtration rate(eGFR)],inflammatory factors[tumor necrosis factor(TNF⁃α),C⁃reactive protein(CRP)and interleukin⁃6(IL⁃6)],humoral immunity[immunoglobulin G(IgG),immunoglobulin M(IgM),immunoglobulin A(IgA)],cellular immunity(CD4^(+)、CD8^(+)and CD4^(+)/CD8^(+))before and after operation and survival rate were compared between the two groups.Results Before surgery,there was no significant difference in HGB,Scr levels,and eGFR between the two groups(P>0.05).On the first day after surgery,there was no significant difference in HGB levels between the two groups(P>0.05);the Scr level in the LPN group was significantly lower than that in the LRN group,while the eGFR level was significantly higher than that in the LRN group,with significant differences(P<0.05).Before surgery,there was no significant difference in the levels of TNF⁃α,CRP and IL⁃6(P>0.05).On the first day after surgery,the levels of TNF⁃α,CRP and IL⁃6 were significantly lower than those in the LRN group,with significant differences(P<0.05).Before surgery,there was no significant difference in humoral and cellular immune indicators between the two groups(P>0.05).On the 1st day after surgery,the levels of IgG,IgM,IgA,CD4^(+),CD8^(+),and CD4^(+)/CD8^(+)in the LPN group were significantly higher than those in the LRN group,with significant differences(P<0.05).There was no significant difference in the 2⁃year survival rate between the two groups(P>0.05).Conclusions Both treatments can improve the prognosis of patients with no difference in survival rate,but laparoscopic partial nephrectomy can preserve part of renal function,reduce inflammation and damage,and improve the immunity of patients.