肾肿瘤临床特点和手术方式变化(单一术者945例报告)

Clinical features and surgical methods of renal tumors:945 cases report by a single surgeon

目的:探讨中国人民解放军总医院单一术者(董隽)2007~2015年肾肿瘤患者临床特点和手术方式变化。方法:回顾性分析2007~2015年诊治945例肾肿瘤患者资料,包括:年龄、性别、肿瘤大小、TNM分期、手术方式、病理类型、保留肾单位手术热缺血时间等。将临床资料分为3个阶段进行比较分析:第1阶段(2007~2009年)以开放手术为主,腹腔镜手术逐步得以应用;第2阶段(2010~2014年)以腹腔镜手术广泛应用为主;第3阶段(2015年)机器人辅助腹腔镜保留肾单位手术广泛开展。结果:2007~2015年,肾肿瘤手术例数逐年增多。男女比例、平均初诊年龄无明显变化,肿瘤最大直径由4.11cm降至3.91cm。T1a、T1b期患者增多,热缺血时间减少。肾肿瘤开放手术比例由2007~2009年的60.36%降至2015年的3.92%;肾肿瘤微创手术比例由2007~2009年的39.64%增至2015年的96.08%。保留肾单位手术比例上升,肾根治性手术比例下降。结论:2007~2015年肾肿瘤临床特点及手术方式已发生明显变化,早期肾肿瘤就诊率增多,微创手术比例上升,开放手术比例下降。机器人辅助腹腔镜保留肾单位手术比例近年来逐渐增大。

Objective:To discuss the clinical characteristics and changes of surgical methods of renal tumors in General Hospital of PLA by a sinlge surgeon(Dong Jun)from 2007 to 2015.Methods:A retrospective review was performed on the clinical data of 945 patients with renal tumors from 2007 to 2015,including age,sex,tumor size,TNM stage,operation pattern,pathological type and warm ischemia time.The clinical data were divided into three stages.At the first stage(2007-2009),open surgery was done,and laparoscopic surgery was gradually applied.At the second stage(2010-2014),laparoscopic surgery was widely used.At the third stage(2015),robotassisted laparoscopic partial nephrectomy was extensively carried out.Results:From 2007 to 2015,the number of surgical operations for renal tumors increased year by year.The ratio of male:female and the average age had no significant changes.The tumor diameters were decreased from 4.11 cm to 3.91 cm.The patients in T1 aand T1b stages were increased,and warm ischemic time shortened.The proportion of open surgery for renal tumors was decreased from 60.36%in 2007-2009 to 3.92%in 2015.The proportion of minimally invasive surgery for renal tumors increased from 39.64% in 2007-2009 to 96.08% in 2015.The proportion of radical nephrectomies decreased,and the proportion of nephron-sparing surgery was increased.Conclusions:The clinical features and surgical methods of renal tumors from 2007 to 2015have changed significantly.The rate of early renal tumors is increased,the proportion of minimally invasive surgery for tumors is increased and the proportion of open surgery is decreased.Robot-assisted laparoscopic partial nephrectomy has been gradually increased in recent years.