后腹腔镜肾部分切除术与肾癌根治术治疗复杂性T1b期肾肿瘤的比较 #br#

目的对比分析后腹腔镜肾部分切除术（RLPN）与后腹腔镜肾癌根治术（RLRN）治疗复杂性T_1b期肾肿瘤的疗效。 方法回顾性纳入2014年11月至2015年11月西安市人民医院收治的68例复杂性T_1b期肾脏肿瘤患者的临床资料，根据手术方法将患者分为RLPN组和RLRN组，每组34例。RLPN组行后腹腔镜肾部分切除术，RLRN组行后腹腔镜肾癌根治术。比较两组患者的围术期相关指标、肾功能情况及生存情况。 结果两组患者手术时间、术中出血量、引流管留置时间、术后住院时间及术后并发症情况比较，差异均无统计学意义（P>0.05）；时间与方法在肾小球滤过率估算值上不存在交互作用（P>0.05），时间与方法在eGFR上主效应均显著（P<0.05）；RLPN组患者术后6个月时eGFR水平高于RLRN组；随访期间，Kaplan-Meier分析显示，RLRN组患者5年总生存率为88.2%，无病生存率为85.3%；RLPN组患者5年总生存率为91.2%，无病生存率为82.4%，两组患者总生存率与无病生存率比较差异无统计学意义（χ²=0.188、0.082，P=0.664、0.774）。 结论RLPN安全有效，可以最大限度地保留正常肾组织，保护肾功能，提高了术后生活质量，且具有与RLRN相当的远期疗效，值得临床推广应用。

Comparison of the efficacy of retroperitoneal laparoscopic partial nephrectomy with retroperitoneal laparoscopic radical nephrectomy for complex T1b renal tumors

ObjectiveTo compare the efficacy of retroperitoneal laparoscopic partial nephrectomy (RLPN) with retroperitoneal laparoscopic radical nephrectomy (RLRN) for complex stage T_1b renal tumors. MethodsThe clinical data of 68 patients with complex T_1b renal tumors in Xi'an People's Hospital from November 2014 to November 2015 were retrospectively included. The patients were divided into RLPN group and RLRN group, each of 34 cases. The RLPN group received retroperitoneal laparoscopic partial nephrectomy, and the RLRN group received retroperitoneal laparoscopic radical nephrectomy. The perioperative related indexes, renal function and survival were compared between the two groups. ResultsThere was no statistically significant difference in operation time, intraoperative blood loss, indwelling drainage tube time, postoperative hospital stay and occurrence of complications between the two groups (P>0.05). There was no interaction between time and method on estimated glomerular filtration rate (eGFR) (P>0.05), but the main effect of time and method on eGFR was significant (P<0.05), the level of eGFR in RLPN group was higher than that in RLRN group at 6 months after operation. During the follow-up period, Kaplan-Meier analysis showed that the 5-year overall survival rate and disease-free survival rate in the RLRN group were 88.2% and 85.3% respectively. The 5-year overall survival rate and disease-free survival rate of patients in the RLPN group were 91.2% and 82.4% respectively, and there was no significant difference between the two groups (χ²=0.188, 0.082, P=0.664, 0.774). ConclusionRLPN is safe and effective, can retain normal renal tissue to the maximum extent, protect renal function, improve postoperative quality of life, and has the same long-term efficacy as RLRN, which is worthy of widespread clinical application.