微波消融辅助后腹腔镜下肾部分切除术治疗中危肾肿瘤

Microwave ablation assisted laparoscopic partial nephrectomy for renal carcinoma with intermediate risk PADUA score

目的:应用微波消融辅助后腹腔镜肾部分切除术(MWA-LPN)治疗中危肾肿瘤(PADUA评分8～9分),以缩短肾脏热缺血时间,保护肾功能。方法:回顾性分析2014年1月～2017年8月我院收治中危肾肿瘤患者157例,79例行微波消融辅助后腹腔镜肾部分切除术(MWA-LPN组),另78例行腹腔镜肾部分切除术(LPN组),比较两组手术时间、热缺血时间、术中出血量、术后并发症、住院天数及肾功能等临床指标。结果:所有手术均获成功,无中转开放。MWA-LPN组和LPN组平均手术时间分别为(90.3±31.9) min、(100.9±23.2) min;平均热缺血时间分别为(10.6±4.1) min、(18.6±2.9) min;术后平均住院天数分别为(4.8±0.9) d、(5.5±1.3) d,两组比较差异均有统计学意义(P<0.05)。MWA-LPN组和LPN组术中平均出血量分别为(132.8±66.7) ml、(129.5±142.4) ml,两组比较差异无统计学意义;两组术后切缘病理均阴性,Scr及eGFR比较差异无统计学意义。MWA-LPN组术后尿瘘1例,血尿1例,切口愈合不良1例,发热2例;LPN组术后尿瘘1例,血尿2例,发热2例,两组比较差异无统计学意义。本组随访12～55个月,平均(26.9±10.6)个月,未发现肿瘤局部复发及远处转移。结论:MWA-LPN具有热缺血时间短、术后恢复快等优点,是一种可供选择的安全、有效的治疗中危肾肿瘤术式,但其远期疗效尚需大样本对照研究和长期随访观察。

Objective:We used microwave ablation assisted laparoscopic partial nephrectomy(MWA-LPN)to treat renal carcinoma with intermediate risk PADUA score to decrease the warm ischemia time and preserve the renal function.Method:From January 2014 to August 2017,157 renal carcinoma patients with intermediate risk PADUA score were admitted in our hospital,among which 79 patients underwent MWA-LPN and the other 78 underwent LPN.The operative time,warm ischemia time,estimated blood loss,complications and hospital stay were compared between the two groups.Result:All patients were operated successfully without conversion to open surgery.The mean operation time was(90.3±31.9)min and(100.9±23.2)min for MWA-LPN and LPN group,respectively.The mean warm ischemia time was(10.6±4.1)min and(18.6±2.9)min,and the mean postoperative hospital stay was(4.8±0.9)d and(5.5±1.3)d for MWA-LPN and LPN group,respectively.The difference between the two groups was significant(P<0.05).The mean estimated blood loss was(132.8±66.7)ml and(129.5±142.4)ml without statistical significance.All tumors were removed with negative surgical margin.The postoperative creatinine and eGFR were normal and there was no significant difference between two groups.Postoperative complications were found in MWA-LPN group including urinary leakage in 1 case,hematuria in 1 case,poor wound healing in 1 case and fever in 2 cases,while urinary leakage in 1 case,hematuria in 2 cases and fever in 2 cases in LPN group.There was no significant difference between two groups.During the mean follow-up period of(26.9±10.6)(range,12-55)months,there was no tumor recurrence or metastasis in both groups.Conclusion:MWA-LPN has the advantages of short warm ischemia time and rapid recovery.It was a safe and effective treatment for renal carcinoma with intermediate risk PADUA score,but its long-term oncological efficacy needs proving by large sample control study and long-term follow-up.