腹腔镜保留肾单位肾肿瘤切除术对肾细胞癌患者手术相关指标、肾功能及血液学指标的影响

Effects of Laparoscopic Nephron Sparing Nephrectomy on Surgical Related Indexes,Renal Function and Hematology Indexes in Patients with Renal Cell Carcinoma

目的探讨腹腔镜保留肾单位肾肿瘤切除术(RPNSS)在肾细胞癌治疗中的应用效果。方法选取80例肾细胞癌患者,按随机数字表法分为2组,各40例。对照组予以腹腔镜根治性肾切除术(LRN)治疗,观察组予以RPNSS治疗。比较2组手术相关指标、肾功能指标、血液学指标及并发症。结果观察组术中出血量为(175.62±15.43)ml,高于对照组的(98.65±7.52)ml;手术时间、住院时间为(105.63±10.28)min、(11.86±1.42)d,长于对照组的(90.15±7.46)min、(9.87±1.32)d;差异均有统计学意义(P<0.05)。观察组术后血肌酐(Scr)、尿素氮(BUN)、24 h尿蛋白水平为(92.52±9.26)μmol/L、(8.04±1.18)mmol/L、(0.28±0.05)g,低于对照组的(108.22±10.34)μmol/L、(9.67±1.24)mmol/L、(0.36±0.08)g,差异有统计学意义(P<0.05)。观察组术后皮质醇(COR)、血管内皮生长因子(VEGF)水平分别为(13.12±1.34)ng/L、(118.69±10.35)ng/L,低于对照组的(16.05±1.42)ng/L、(134.87±13.45)ng/L,差异有统计学意义(P<0.05)。2组并发症相比,差异无统计学意义(P>0.05)。结论RPNSS在肾细胞癌治疗中能够更好地保留患者肾功能,但手术时间长、术中出血量多,临床需综合考虑,慎重选择。

Objective To investigate the effect of laparoscopic nephron sparing nephrectomy(RPNSS)in the treatment of renal cell carcinoma.Methods 80 patients with renal cell carcinoma were selected and randomly divided into 2 groups,with 40 patients in each group.The control group received laparoscopic radical nephrectomy(LRN)treatment,while the observation group received RPNSS treatment.The operation related indexes,renal function indexes,Hematology indexes and complications were compared between the 2 groups.Results The intraoperative bleeding volume in the observation group was(175.62±15.43)ml,which was higher than that in the control group(98.65±7.52)ml,and the surgical time and hospital stay were(105.63±10.28)minutes and(11.86±1.42)days,which were longer than those in the control group(90.15±7.46)minutes and(9.87±1.32)days,with statistical significance(P<0.05);The levels of serum creatinine(Scr),Blood urea nitrogen(BUN)and 24h urinary protein in the observation group were(92.52±9.26)μMol/L,(8.04±1.18)mmol/L,(0.28±0.05)g,lower than the control group's(108.22±10.34)μMol/L,(9.67±1.24)mmol/L,(0.36±0.08)g,the difference was statistically significant(P<0.05);The postoperative levels of cortisol(COR)and Vascular endothelial growth factor(VEGF)in the observation group were(13.12±1.34)ng/L,(118.69±10.35)ng/L,lower than those in the control group(16.05±1.42)ng/L,(134.87±13.45)ng/L,with statistical significance(P<0.05);There was no statistically significant difference in complications between the two groups(P>0.05).Conclusion RPNSS can better preserve the patient's renal function in the treatment of renal cell carcinoma,but the long surgical time and high intraoperative bleeding require comprehensive clinical consideration and careful selection.