2018 年第 8 期 第 13 卷

腹腔镜下保留肾单位手术与根治性肾切除术治疗新发局限性肾癌的临床效果分析

Clinical effects of laparoscopic nephron-sparing surgery and radical nephrectomy on localized renal carcinoma

作者：薛玉泉王振龙张亚萍种铁

英文作者：

单位：710004西安交通大学第二附属医院泌尿外科

英文单位：

关键词：局限性肾癌;腹腔镜;保留肾单位手术;根治性肾切除术;肾功能

英文关键词：

• 摘要：

• 【摘要】目的    探讨腹腔镜下保留肾单位手术（NSS）与根治性肾切除术（RN）治疗新发局限性肾癌的临床效果。方法    选择2015年1月至2017年6月西安交通大学第二附属医院收治的新发局限性肾癌患者220例，根据手术方式不同将220例患者分为腹腔镜下NSS组（观察组95例）和腹腔镜下RN组（对照组125例），比较2组患者手术时间、术中出血量、手术前后血肌酐水平的差异，术后门诊随访观察患者肿瘤转移及复发情况。结果    2组患者中转开腹及术后并发症发生率以及引流时间、术后禁食时间和住院时间比较差异均无统计学意义（均P>0.05），观察组手术时间长于对照组、术中出血量多于对照组［(117±23)min比（86±32）min，（98±24）ml比（71±12）ml］，差异均有统计学意义（均P<0.05）。术前观察组与对照组患者血肌酐水平［(95±12)μmol/L比(98±12)μmol/L］比较差异无统计学意义（P>0.05）。术后1 d和术后3、6个月，2组血肌酐水平均高于术前，但观察组低于对照组［(112±17)μmol/L比(124±18)μmol/L，(110±14)μmol/L比(120±15)μmol/L，(108±13)μmol/L比(120±14)μmol/L］，差异均有统计学意义（均P<0.05）。术后随访6~24个月，2组均无肿瘤复发、转移及死亡。结论    腹腔镜下NSS和RN均可有效治疗局限型肾癌，但相对RN，NSS可减轻对患者肾功能的损伤，更有利于患者预后。

• Objective    To analyze the clinical effects of laparoscopic nephron-sparing surgery(NSS) and radical nephrectomy(RN) on localized renal carcinoma. Methods    A total of 220 patients with localized renal carcinoma admitted between January 2015 and June 2017 in the Second Affiliated Hospital of Xi′an Jiaotong University were randomly divided into observation group(n=95) and control group(n=125). The observation group was treated with laparoscopic NSS and the control group was treated with laparoscopic RN. Operation time, intraoperative blood loss, serum creatinine level, metastasis and recurrence were analyzed. Results    Conversion to laparotomy rate, postoperative incidence of complications, drainage volume, fasting time and hospital stay time showed no significant differences between groups（P>0.05）. Operation time in observation group was significantly longer and intraoperative blood loss was significantly more than those in control group［(117±23)min vs （86±32）min， （98±24）ml vs （71±12）ml］(P<0.05). Before surgery, serum creatinine had no significant between observation group and control group［(95±12)μmol/L vs (98±12)μmol/L］（P>0.05）. One day and 3, 6 months after surgery, serum creatinine level was significantly higher than that before surgery; serum creatinine levels in observation group were significantly lower than those in control group［(112±17)μmol/L vs (124±18)μmol/L， (110±14)μmol/L vs (120±15)μmol/L， (108±13)μmol/L vs (120±14)μmol/L］(P<0.05). No tumor recurrence, metastasis and death occurred during 6-24 months of follow-up. Conclusions    Both laparoscopic RN and NSS are effective in treatment of localized renal carcinoma. NSS can reduce renal damage more effectively than RN.