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后腹腔镜保留肾单位的肾部分切除术对T1期肾肿瘤的临床效果

Effect of retroperitoneal laparoscopic partial nephrectomywith nephron-sparing surgery for T1 stage renal tumors

    摘要
  • 摘要:
      目的  探讨后腹腔镜保留肾单位的肾部分切除术对T1期肾肿瘤的临床疗效及对肾功能与生存质量的影响。
      方法  将本院收治的100例经临床诊断为T1期肾肿瘤患者随机分为对照组与观察组。对照组给予开放式部分肾单位切除术，观察组给予后腹腔镜保留肾单位的肾部分切除术。比较2组术后临床疗效，手术相关情况，肝、肾功能情况，生存质量评分、术后并发症和复发率情况。
      结果  术后1周，观察组总有效率优于对照组(P < 0.05); 观察组手术时间、术中出血量、术后住院时间、术后失血量、肾蒂血管阻断时间均优于对照组(P < 0.05), 但术中输血率差异无统计学意义(P>0.05); 手术后2组患者肝、肾功能水平均下降，观察组术后尿素氮(BUN)、血肌酐(Scr)、尿酸(UA)、内生肌酐清除率(Ccr)、肾小球滤过率(GFR)指标变化幅度显著大于对照组(P < 0.05); 观察组术后1、3、6个月生存质量评分均高于对照组(P < 0.05); 随访1、2、3年观察组患者生存率高于对照组，但差异无统计学意义(P>0.05); 观察组漏尿、血肿、切口感染等并发症总发生率、复发率均低于对照组，但差异均无统计学意义(P>0.05)。
      结论  后腹腔镜保留肾单位的肾部分切除术与传统的开放式肾部分切除术相比在临床疗效、手术相关情况、肝功能、肾功能、生存质量以及并发症上都存在一定优势。

     

    Abstract:
      Objective  To investigate the clinical efficacy of retroperitoneal laparoscopic partial nephrectomy with nephron-sparing surgery for T1 stage renal tumor and its effect on renal function and quality of life.
      Methods  A total of 100 patients with T1 stage renal tumor admitted to our hospital were randomly divided into control group and observation group, receiving open partial nephrectomy, retroperitoneal laparoscopic partial nephrectomy with nephron-sparing surgery, respectively. Postoperative clinical efficacy, surgical related conditions, liver and kidney functions, quality of life scores, postoperative complications and recurrence rates of the two groups were compared.
      Results  At 1 week after the operation, the total effective rate of the observation group was significantly better than that in the control group(P < 0.05). The operative time, intraoperative blood loss, postoperative hospital stay and postoperative blood loss as well as time of renal pedicle vessel occlusion in the observation group were significantly better than those in the control group (P < 0.05). Intraoperative blood transfusion rate in two groups showed no significant difference(P>0.05). Liver and kidney functions of the two groups were reduced after surgery, and blood urea nitrogen (BUN), serum creatinine (Scr), uric acid (UA), endogenous creatinine clearance (Ccr), glomerular filtration rate (GFR) changed more significantly in the observation group than those in the control group (P < 0.05). The scores of survival quality at 1, 3 and 6 months after surgery of the observation group were significantly higher than that of the control group (P < 0.05). The survival rates of the observation group were higher than that of the control group after follow-up for 1, 2 and 3 years, showing no significant difference (P>0.05); the incidences of complications such as urine leakage, hematoma, incision infection and bleeding as well as recurrence rate in the observation group were significantly lower than that in the control group, but no significant differences were found in two groups(P>0.05).
      Conclusion  Compared with traditional open partial nephrectomy, retroperitoneal laparoscopic partial nephrectomy with nephron-sparing surgery has advantages in clinical efficacy, surgical conditions, liver and kidney function, quality of life and complications.

     

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