后腹腔镜肾部分切除术治疗T1a期肾癌

目的：探讨后腹腔镜肾部分切除术治疗T1a期肾癌的临床价值.方法：回顾性分析2011年9月至2012年12月16例采用后腹腔镜肾部分切除术治疗的T1a期肾癌患者的临床资料,评价手术方法的优点和缺点.结果：16例手术均顺利完成,无中转开放手术者.手术时间为100-155min.16例均单纯阻断肾动脉,热缺血时间为20-30min.术中失血量120-260ml.术后镇痛药用量6-40mg（相当于硫酸吗啡量）;引流管留置时间2-3d,进食时间18-36h,住院天数7-12d.无术后出血、感染、漏尿等并发症.术后病理检查均为肾透明细胞癌,切缘均为阴性.随访1-16个月均健在,肿瘤无局部复发、转移.随访期间患者肾功能均正常.结论：后腹腔镜肾部分切除术治疗T1a期肾癌安全可行,具有创伤小、恢复快等优点,但远期疗效需进一步观察.     

后腹腔镜肾部分切除术治疗T1a期肾癌

目的:探讨后腹腔镜肾部分切除术治疗T1a期肾癌的临床价值。方法:回顾性分析2011年9月至2012年12月16例采用后腹腔镜肾部分切除术治疗的T1a期肾癌患者的临床资料,评价手术方法的优点和缺点。结果:16例手术均顺利完成,无中转开放手术者。手术时间为100-155min。16例均单纯阻断肾动脉,热缺血时间为20-30min。术中失血量120-260ml。术后镇痛药用量6-40mg(相当于硫酸吗啡量);引流管留置时间2-3d,进食时间18-36h,住院天数7-12d。无术后出血、感染、漏尿等并发症。术后病理检查均为肾透明细胞癌,切缘均为阴性。随访1-16个月均健在,肿瘤无局部复发、转移。随访期间患者肾功能均正常。结论:后腹腔镜肾部分切除术治疗T1a期肾癌安全可行,具有创伤小、恢复快等优点,但远期疗效需进一步观察。     

后腹腔镜肾部分切除术与开放手术治疗局限性肾癌的疗效比效

目的 比较后腹腔镜肾部分切除术(RLPN)与开放肾部分切除术(PN)治疗局限性肾癌的疗效与安全性.方法 选取行肾部分切除术的局限性肾癌患者共98例,其中52例行后腹腔镜肾部分切除术,另外46例行开放肾部分切除术,观察比较两组患者的一般资料、术中及术后各项参数,并对患者进行随访,观察效果.结果RLPN组患者术中出血量、术后肠道功能恢复时间、术后住院天数均少于或短于PN组(P﹤0.05);两组患者手术时间、术中肾热缺血时间及术后血肌酐(Cr)、血红蛋白(Hb)变化幅度比较,差异均无统计学意义(P﹥0.05).结论 后腹腔镜肾部分切除术治疗局限性肾癌与开放肾部分切除术比较疗效相当,手术创伤小,患者术后恢复更快,随着手术技巧的提高,可能逐渐取代开放手术.     

肾癌后腹腔镜下肾部分切除术与开放性肾部分切除术的比较研究

目的　分析后腹腔镜下肾部分切除术（ＲＬＰＮ）及开放性肾部分切除术（ＯＰＮ）治疗肾癌的有效性及安全性。方法　回顾性分析２００６年２月至２００９年８月我院收治的行肾部分切除术７９例肾癌患者（肿瘤最大径≤４ｃｍ）,平均年龄５３.９岁。７９例患者分为ＲＬＰＮ组（４２例）和ＯＰＮ组（３７例）,比较两组肾蒂阻断时间、手术时间、术中出血量、术中输血率、术后并发症、住院时间以及生存随访情况等。结果　ＲＬＰＮ组和ＯＰＮ组肾蒂血管阻断时间、手术时间以及术后住院时间分别为（３２.１０±５.７１）ｍｉｎ和（２３.１０±４.６８）ｍｉｎ、（１０９.９０±２０.４０）ｍｉｎ和（１２０.３０±１７.５２）ｍｉｎ、（７.８０±１.４１）ｄ和（９.１０±１.７９）ｄ,两组比较差异均有统计学意义（Ｐ＜０.０５）;术中出血量和术中输血率分别为（１０７.０±７３.９９）ｍｌ和（１３０.２０±８９.５１）ｍｌ、２.４％（１／４２）和２.７％（１／３７）,两组比较差异无统计学意义（Ｐ＞０.０５）;术后并发症分别为２.４％（１／４２）和８.１％（３／３７）,两组比较差异无统计学意义（Ｐ＞０.０５）。两组术后随访１８～６０个月,无复发或转移,１年生存率为１００％。结论　对于较小的肾癌,ＲＬＰＮ术式的手术时间较短,术后患者恢复快,但受限于操作条件和技术,肾蒂阻断时间较长,值得在具备条件的医院推广。     

腹膜后腹腔镜下肾部分切除术和根治性肾切除术治疗小肾癌的临床比较

目的探讨腹膜后腹腔镜下肾部分切除术和根治性肾切除术治疗小肾癌的临床疗效。方法将35例小肾癌患者依据手术治疗方式的不同分为A组(腹膜后腹腔镜下肾部分切除术组)20例和B组(腹膜后腹腔镜下根治性肾切除术组)15例。结果两组小肾癌患者手术时间、术中出血量、住院时间、术前和术后24h肌酐、1年、2年、3年生存率差异均无统计学意义(P>0.05)。结论腹膜后腹腔镜下肾部分切除术与根治性肾切除术治疗小肾癌无明显差异,效果较好,值得临床推广应用。     

机器人辅助腹腔镜与后腹腔镜肾部分切除术治疗早期肾癌的疗效比较

目的 比较机器人辅助经腹腹腔镜肾部分切除术（RALPN）与后腹腔镜下肾部分切除术（RLPN）治疗早期肾癌的疗效和安全性,探讨RALPN的临床应用价值。方法 选取2010年5月至2013年10月收治的70例肾癌患者,根据术式的不同分为RALPN组（n=36）和RLPN组（n=34）。比较两组手术时间、肾动脉阻断时间、术中出血量、术中输血率、术后住院时间及术后并发症发生情况。结果 除RLPN组有2例术中转开放手术,两组均成功完成手术。RALPN组和RLPN组的手术时间、肾动脉阻断时间、术中出血量、术后住院时间分别为（90.5±12.6）min和（110.7±20.3）min、（15.2±5.8）min和（24.6±7.2）min、（50.2±9.5）ml和（130.2±22.4）ml、（6.1±1.7）d和（7.8±2.2）d,两组比较差异均有统计学意义（P＜0.05）。RALPN组和RLPN组的术中输血率分别为0和11.8%。RALPN组术后出现1例肾周血肿,RLPN组出现1例尿漏和2例继发性出血。两组在随访期间均为无瘤生存。结论RALPN是治疗肾癌安全、有效的微创术式。     

后腹腔镜肾癌根治术治疗T2期肾癌临床疗效观察

目的探讨后腹腔镜肾癌根治术治疗T2期肾癌的术中出血量和并发症。方法选取2016年12月至2018年12月间营口市中心医院收治的76例肾癌患者,根据治疗方法不同分为观察组和对照组,每组38例。采用开放性肾癌根治术治疗的纳入对照组,采用后腹腔镜肾癌根治术治疗的纳入观察组。比较两组患者的手术相关指标情况、治疗后7日炎性指标情况以及并发症发生情况。结果观察组患者术中出血量和住院时间比对照组少,手术时间比对照组多,差异均有统计学意义(均P <0. 05)。观察组患者治疗后白细胞介素6(IL-6)和C反应蛋白(CRP)均低于对照组,差异均有统计学意义(均P <0. 05)。两组患者治疗后的肿瘤坏死因子α和血沉比较,差异无统计学意义(P>0. 05)。观察组患者的并发症发生率为7. 9%,明显低于对照组患者的23. 7%,差异有统计学意义(P <0. 05)。结论后腹腔镜肾癌根治术治疗T2期肾癌,能减少患者的术中出血量,缩短住院时间,降低IL-6和CRP水平,减少并发症发生。     

超选择性肾动脉栓塞联合经腹腹腔镜肾部分切除术在老年T1b期肾癌中的应用

目的:探讨DSA超选择性肾动脉栓塞联合经腹腹腔镜肾部分切除术治疗老年T1b期肾癌的安全性及可行性。方法:选择2016年1月至2018年1月于辽宁省肿瘤医院因罹患T1b期肾癌而行肾部分切除术的22例老年患者,进行回顾性研究。术前1~12 h先在介入手术室行DSA超选择性肾肿瘤靶动脉栓塞,然后再行经腹腹腔镜下零缺血肾部分切除术。对于术中手术时间、术中出血量、输血情况、术后胃肠道功能恢复所需时间、术后引流管拔除时间、术后并发症、术后住院时间、术后组织病理学指标等进行统计分析,并且术后进行随访统计肿瘤的复发和转移情况。结果:所有手术均成功完成,无中转改开放病例,无死亡病例,仅1例因肿瘤切除过程中出血较多,采用动脉夹暂时阻断肾动脉主干,阻断时间约为14 min。术中手术时间为（152.22±7.34） min,术中出血量为（102.27±66.82） ml,术后胃肠道功能恢复时间为（1.45±0.60） d,腹腔引流管拔除时间为（2.91±0.75） d,术后住院时间为（6.27±1.12） d,术后并发症发生率为9.09%,术中和术后输血率分别为4.54%和4.54%。所有患者均术后随访12~36个月,暂未发现肿瘤复发与转移。结论:超选择性肾动脉栓塞联合经腹腹腔镜肾部分切除术治疗老年T1b期肾癌安全、可行。     

Oncologic and Functional Outcomes of Radical and Partial Nephrectomy in pT3a Pathologically Upstaged Renal Cell Carcinoma: A Multi-institutional Analysis

BackgroundThe efficacy of partial nephrectomy (PN) in setting of pT3a pathologic-upstaged renal cell carcinoma (RCC) is controversial. We compared oncologic and functional outcomes of radical nephrectomy (RN) and PN in patients with upstaged pT3a RCC.Patients and MethodsThis was a multicenter retrospective analysis of patients with cT1-2N0M0 RCC upstaged to pT3a postoperatively. The primary outcome was recurrence-free survival, with secondary outcomes of overall survival and de novo estimated glomular filtration rate (eGFR) < 60. Multivariable analysis was performed to identify predictive factors for oncologic outcomes. Kaplan-Meier analyses (KMA) were obtained to elucidate survival outcomes.ResultsA total of 929 patients had pT3a upstaging (686 [72.6%] RN; 243 [25.7%] PN; mean follow-up, 48 months). Tumor size was similar (RN 7.7 cm vs. PN 7.3 cm; P = .083). PN had decreased ΔeGFR (6.1 vs. RN 19.4 mL/min/1.73m²; P < .001) and de novo eGFR < 60 (9.5% vs. 21%; P = .008). Multivariable analysis for recurrence showed increasing RENAL score (hazard ratio [HR], 3.8; P < .001), clinical T stage (HR, 1.8; P < .001), positive margin (HR, 1.57; P = .009), and high grade (HR, 1.21; P = .01) to be independent predictors, whereas surgery was not (P = .076). KMA revealed 5-year recurrence-free survival for cT1-upstaged PN, cT1-upstaged RN, cT2-upstaged PN, and cT2-upstaged RN of 79%, 74%, 70%, and 51%, respectively (P < .001). KMA revealed 5-year overall survival for cT1-upstaged PN, cT1-upstaged RN, cT2-upstaged PN, and cT2-upstaged RN of 64%, 65.2%, 56.4%, and 55.2%, respectively (P = .059).ConclusionsIn pathologically upstaged pT3a RCC, PN did not adversely affect risk of recurrence and provided functional benefit. Surgical decision-making in patients at risk for T3a upstaging should be individualized and driven by tumor as well as functional risks.     

Prognosis in Renal Cell Carcinoma: Analysis of Clinical Course following Nephrectomy

The clinical courses and survivals of 159 patients who underwentnephrectomy for renal cell carcinoma are reviewed. A longerdiseae-free period after nephrectomy was correlated with significantlybetter survival. Among patients in whom metastases in the lungsor bones were detected after nephrectomy, those with betweenone and five pulmonary or solitary bone metastases, wihtoutdefinite increases in their number and size in the six monthsfollowing their first appearance, survived significantly longerthan patients with a similar number of metastases but whichdid increase in number and size in the following six months,or patients with six or more pulmonary or multiple bone metastases.Even when metastases detected after nephrectomy were confinedto the lungs or bones throughout the observation period, thepatients did not necessarily show significantly better survivalsthan patients with metastases detected in multiple sites.     

不同入路腹腔镜下肾部分切除术治疗早期肾癌患者的临床效果对比分析

目的 比较早期肾癌患者应用不同入路腹腔镜下肾部分切除术(LPN)治疗的临床效果.方法 选择60例早期肾癌患者,采用随机数字表法分为2组,每组30例.对照组经腹入路,观察组经后腹腔入路,对比2组近期疗效、围术期相关指标、应激反应指标及并发症发生情况.结果 2组临床疾病控制率比较,差异无统计学意义(P>0.05),观察组手...     

后腹腔镜根治性肾切除术治疗局限性肾癌的疗效研究

目的 研究后腹腔镜根治性肾切除术(laparoscopic radical nephrectomy,LRN)治疗局限性肾癌的效果及安全性.方法 选择局限性肾癌患者80例,分为LRN组39例和传统开放肾癌根治术(open radical nephrectomy,ORN)41例(ORN组),比较两组的临床疗效.结果 与ORN组相比,LRN组手术时间、住院时间、术后肠功能恢复时间、术中出血量、白细胞、C-反应蛋白、肌酐和尿素氮均明显降低(P<0.05);LRN组的切口感染、术后出血、深静脉血栓形成、肺部感染、气胸、泌尿系统感染等并发症发生率为12.82%,明显低于对照组的29.27%(P<0.05);随访3~30个月,LRN组有1例术后5个月出现双肺转移,经口服索拉非尼后,现在病情已平稳;ORN组有1例术后4个月出现双肺转移,2例术后1年出现肿瘤全身转移.结论 后腹腔镜根治性肾切除术治疗局限性肾癌安全、有效,与传统开放手术相比,具有术后恢复快、创伤小、并发症少等优点,临床应用价值更高.     

Percutaneous Ablation Versus Robotic Partial Nephrectomy in the Treatment of cT1b Renal Tumors: Oncologic and Functional Outcomes of a Propensity Score-weighted Analysis

IntroductionThe purpose of this study was to assess oncologic and functional outcomes of both percutaneous ablation (cryoablation and radiofrequency ablation) and robot-assisted partial nephrectomy (RAPN) in the treatment of renal tumors larger than 4 cm.Materials and MethodsWe retrospectively analyzed prospectively collected data from 102 consecutive patients, who underwent minimally invasive treatment for cT1b renal tumors at our institution. Primary renal function outcome was assessed by estimated glomerular filtration rate preservation at baseline and 1 year postoperatively. Perioperative data and functional and oncologic outcome were collected. Multivariate regression models were used to compare functional outcomes between groups. Cancer-specific survival and recurrence-free survival were estimated at 2 years using the Kaplan-Meier method and compared with Cox proportional hazards regression model to calculate hazard ratios (HRs). To control for selection bias between the different treatments, we adjusted our models with an inverse probability of treatment weighting propensity score.ResultsThere was no significant difference in renal preservation between the groups (P = .664). Multivariate analysis did not show a statistically significant difference in terms of renal function outcomes between the RAPN and percutaneous thermal ablation groups. The adjusted HR regarding the local recurrence-free survival was significantly shorter for the cryoablation group (HR, 4.3; 95% confidence interval, 1.78-10.37; P = .001).ConclusionsOur study demonstrated the equivalence between RAPN and percutaneous ablative techniques for the preservation of renal function in the treatment of T1b tumors. RAPN offers a better local control than percutaneous ablation, in terms of primary success rate.     

≤4cm肾细胞癌手术方式和预后比较

目的：探讨≤4cm肾细胞癌患者的手术方式和预后特点。方法：分析1992年1月至2002年12月诊断为肾细胞癌的75例患者的临床表现、手术方式和预后生存。结果：75例≤4cm的肾细胞癌患者均行手术治疗，其中50例（66．7％）为偶发性肾癌，有症状的25例（33．3％）。19例（253％）行肾部分切除术，56倒（74．7％）行肾癌根治术。肿瘤大小中位数为3．2cm（1．2-4cm）。平均随访时间60个月（1～1J8个月），肾部分切除术和肾癌根治术的5年生存率分别为95．4％。84．7％、5年肿瘤特异生存率为100％．结论：对于≤4cm的局限性肾细胞癌，无论是肾部分切除术或肾癌根治术．都有良好的预期生存.     

后腹腔镜下肾部分切除术对局限性肾癌的疗效分析

目的探讨后腹腔镜下肾部分切除术(RLPN)对局限性肾癌(LRCC)的疗效及安全性。方法对肿瘤直径>4 cm且≤7 cm的LRCC患者68例,均行肾部分切除术(PN),其中RLPN组34例,开放的肾部分切除术(OPN)组34例,对比分析两组的疗效。结果 68例LRCC患者PN术均顺利完成。RLPN组与OPN组LRCC患者性别、年龄、瘤体直径、病程、术前术后肌酐与GFR、引流量等比较,差异均无统计学意义(P均>0.05)。RLPN组手术耗时、血管阻断时间长于OPN组,差异具有统计学意义(P均<0.05);RLPN组输血病例少于OPN组(P均<0.05);RLPN组拔管时间、肠道恢复时间、术后住院时间均明显短于OPN组(P均<0.05)。RLPN组患者围术期无中转开放、输血病例,术后出现1例尿瘘;OPN组围术期有5例输血病例。结论 RLPN能达到与OPN治疗相近的治疗结果,即可保留肾单位又具有微创效果,改善患者预后,是治疗瘤体直径>4 cm且≤7 cm LRCC较为安全可靠的手术方式。     

Stereotactic Body Radiotherapy for Renal Cell Carcinoma: Oncological and Renal Function Outcomes

AimsTo evaluate oncological and renal function outcomes of stereotactic body radiotherapy (SBRT) for medically inoperable patients with localised renal cell carcinoma.Materials and methodsConsecutive patients treated with curative intent SBRT (30–45 Gy in five fractions or 42 Gy in three fractions) were included. Data on local control (Response Evaluation Criteria in Solid Tumors [RECIST] v1.1), distant metastasis, impact on estimated glomerular filtration rate (eGFR) and proportional ipsilateral and contralateral renal functions (measured through renal scans) were collected. Univariate and multivariable analyses were conducted to determine association of variables with oncological and renal function outcomes.ResultsSeventy-four patients were analysed. The median follow-up was 27.8 months (interquartile range 17.6–41.7). Fifty-seven per cent had tumours ≥ T1b. One-, 2- and 4-year cumulative incidence of local failure was 5.85, 7.77 and 7.77%, respectively. The cumulative incidence of distant metastasis at 2 years was 4.24%. On multivariable analysis, a lower planning target volume (PTV) mean dose (P = 0.019) and a larger PTV (P = 0.005) were significantly associated with the risk of developing local failure. A lower PTV maximum dose (P = 0.039) was significantly associated with the risk of developing distant metastasis. The median change in global eGFR (ml/min) from pre-SBRT levels was –7.0 (interquartile range –14.5 to –1.0) at 1 year and –11.5 (interquartile range –19.5 to –4.0) at 2 years. The proportion of ipsilateral (differential) renal function decreased over time from 47% of overall renal function pre-SBRT to 36% at 2 years, whereas the proportion of contralateral renal function correspondingly improved. On multivariable analysis, a higher volume of uninvolved renal cortex (P < 0.0001) was significantly associated with a smaller decrease in eGFR over time.ConclusionIn this large institutional cohort, oncological outcomes of renal cell carcinoma treated with SBRT were favourable and a longitudinal decline in renal function in the ipsilateral kidney and compensatory increase in the contralateral kidney were observed. Clinical and dosimetric factors were significantly associated with oncological and renal function outcomes.     

Incident Chronic Kidney Disease After Radical Nephrectomy for Renal Cell Carcinoma

BackgroundChronic kidney disease (CKD) after surgery for kidney cancer is common, and is associated with increased morbidity and mortality. This study aimed to identify factors associated with incident CKD in patients managed with radical nephrectomy.Patients and MethodsAll patients diagnosed with renal cell carcinoma between January 2012 and December 2013 were ascertained from state-based cancer registries in Queensland and Victoria. Information on patient, tumor, and health service characteristics was obtained via chart review. Multivariable logistic regression was used to evaluate exposures associated with incident CKD (estimated glomerular filtration rate [eGFR] <60 mL per minute per 1.73 m²) at 12 months after nephrectomy.ResultsOlder age (adjusted odds ratio [aOR] per 5-year increase, 1.5; 95% confidence interval [CI], 1.4-1.6), male sex (aOR, 1.4; 95% CI, 1.0-2.0), obese compared with not obese (aOR, 1.8; 95% CI, 1.2-2.7), rural compared with urban place of residence (aOR, 1.8; 95% CI, 1.1-3.0) were associated with a higher risk of incident CKD. Lower preoperative eGFR was also associated with a higher risk of incident CKD. Management in private compared with public hospitals was also associated with a higher risk of CKD (aOR, 1.6; 95% CI, 1.2-2.2). Factors related to tumor size and cancer severity were also associated with worse postoperative kidney function, although it is likely this was a consequence of selection bias.ConclusionPatient characteristics have the strongest associations with incident CKD after radical nephrectomy. Potential risk factors were reasonably similar to recognized CKD risk factors for the general population. Patients who undergo nephrectomy who have CKD risk factors might benefit from ongoing postoperative screening for deterioration of kidney function.     

后腹腔镜肾癌根治术治疗41例肾癌的临床观察

目的：探讨后腹腔镜肾癌根治术的手术方法及其临床效果。方法：本组患者均采用气管插管麻醉。在腹腔镜下行患肾切除术。结果：手术时间100—160分钟，平均120分钟；术中出血量40—300ml，平均80ml。肠道恢复时间为术后1-3天，平均1．5天。术后2-4天开始进食。手术后7—12天痊愈出院。术后随访1—19个月，平均随访8个月，一般状况均良好，无肿瘸复发及转移。结论：后腹腔镜肾癌根治术具有创伤小、解剖清晰、术中出血少、术后恢复快等优点，是一种安全、有效的治疗方法。