腹膜后肾肿瘤切除术治疗儿童双侧肾母细胞瘤疗效及对围手术期指标和术后并发症的影响

Efficacy of retroperitoneal nephrectomy on bilateral nephroblastoma in children and its influence on perioperative indicators and postoperative complications

目的 探究腹膜后肾肿瘤切除术治疗儿童双侧肾母细胞瘤的疗效及对围手术期指标和术后并发症的影响。方法 回顾性选取2015年8月至2020年7月期间徐州市儿童医院普外科收治的67例双侧肾母细胞瘤患儿作为研究对象,根据治疗方法不同将其分为腹腔组(n=32)与腹膜后组(n=35)。采用倾向性匹配评分法排除基线资料混杂因素,最终两组各纳入31例。腹腔组实施经腹腔路径肾肿瘤切除手术治疗,腹膜后组实施经腹膜后路径肾肿瘤切除手术治疗。比较两组患儿围手术期指标(手术时间、出血量、术后拔管时间、术后总引流量、住院时间)、并发症发生率、手术后肾功能恢复时间及血清肌酐水平、术后3个月肿瘤标志物指标[血清神经元特异性烯醇化酶(NSE)、儿茶酚胺、乳酸脱氢酶(LDH)]水平;随访36个月,比较两组生存预后情况。结果 腹膜后组的手术时间、术后拔管时间、总引流量及住院时间分别为(128.35±14.42) min、(5.42±1.04) d、(202.42±13.34) mL、(13.05±2.45) d,均显著低于腹腔组[(145.94±17.69) min、(6.37±1.13) d、(226.25±16.48) mL、(19.63±2.71) d],而出血量为(135.35±19.52) mL,显著高于腹腔组[(106.63±15.47) mL],差异均有统计学意义(P<0.05)。腹膜后组并发症发生率(12.90%)与腹腔组(16.13%)比较,差异无统计学意义(P>0.05)。腹膜后组患儿肾功能恢复时间为(13.14±3.62) d,显著低于腹腔组[(15.27±3.48) d],差异有统计学意义(P<0.05);术后3 d,两组患儿血清肌酐水平比较,差异无统计学意义(P>0.05)。术后3个月,两组患儿血清NSE、儿茶酚胺及LDH水平比较,差异均无统计学意义(P>0.05)。两组均随访36个月,腹膜后组死亡7例,总生存期(OS)为(32.48±7.88)个月,无进展生存期(PFS)为(30.13±9.05)个月,腹腔组死亡8例,OS为(31.97±8.05)个月,PFS为(29.62±9.29)个月,两组OS、PFS比较,差异均无统计学意义(P>0.05)。结论 腹膜后肾肿瘤切除术与腹腔路径肾肿瘤切除术治疗儿童双侧肾母细胞瘤均具有较好疗效,能显著改善患儿预后生存状态,但腹膜后肾肿瘤切除术术后恢复更快,更具优势。

Objective To explore the efficacy of retroperitoneal nephrectomy on bilateral nephroblastoma in children and its influence on perioperative indicators and postoperative complications.Methods A total of 67 children with bilateral nephroblastoma admitted to the Department of General Surgery,Xuzhou Children's Hospital from August 2015 to July 2020 were retrospectively selected as the study subjects.They were divided into the abdominal group(n=32) and the retroperitoneal group(n=35) based on different treatment methods.The propensity matching score method was used to exclude confounding factors in baseline data,with 31 cases in each group.The abdominal group was treated with transabdominal nephrectomy,and the retroperitoneal group was given retroperitoneal nephrectomy.Perioperative poriod indicators(surgical time,blood loss,postoperative extubation time,total postoperative drainage volume,hospital stay),incidence rates of complications,postoperative renal function recovery time,serum creatinine level and tumor markers [serum neuron-specific enolase(NSE),catecholamine,lactate dehydrogenase(LDH)] at 3 months after surgery were compared between both groups of children.After 36 months of follow-up,the survival prognosis was compared.Results The surgical time,postoperative extubation time,total drainage volume,and hospitalization stay of the retroperitoneal group were(128.35±14.42) min,(5.42±1.04) d,(202.42±13.34) mL,and(13.05±2.45) d,respectively,significantly lower than those of the abdominal group [(145.94±17.69) min,(6.37±1.13) d,(226.25±16.48) mL,and(19.63±2.71) d],while the blood loss was(135.35±19.52) mL,which was significantly higher than that of the abdominal group [(106.63±15.47) mL],the differences were statistically significant(P<0.05).There was no statistically significant difference in the total incidence of complications between retroperitoneal group(12.90%) and abdominal group(16.13%)(P>0.05).The recovery time of renal function in the retroperitoneal group was(13.14±3.62) d,which was significantly lower than that in the abdominal group [(15.27±3.48) d],and the difference was statistically significant(P<0.05);after 3 days of surgery,there was no statistically significant difference in serum creatinine levels between the two groups of children(P>0.05).There were no statistically significant differences in the levels of serum NSE,catecholamine and LDH between the two groups(P>0.05).The two groups were followed up for 36 months.The number of dead patients,overall survival(OS) and progression-free survival(PFS) were 7 cases,(32.48±7.88) months and(30.13±9.05) months in retroperitoneal group and those in abdominal group were 8 cases,(31.97±8.05) months and(29.62±9.29) months.There were no statistically significant differences in OS and PFS between the two groups(P>0.05).Conclusion Both retroperitoneal nephrectomy and transabdominal nephrectomy have good efficacy in the treatment of bilateral nephroblastoma in children,and can significantly improve the prognosis survival status of children,but retroperitoneal nephrectomy has faster postoperative recovery and is more advantageous.