后腹腔镜下根治性肾切除术127例随访

目的 探讨后腹腔镜下根治性肾切除术的治疗效果及预后. 方法后腹腔镜下根治性肾切除术患者127例,随访发生手术并发症患者的预后情况,术后肾功能情况.通过Kaplan-Meier法分析患者1、3年总生存率、无瘤生存率和肿瘤特异生存率,不同病理分期总生存率、无瘤生存率和肿瘤特异生存率,以及不同病理分期生存率之间的差异.使用Karnofsky行为表现量表评估患者术后生活质量. 结果 127例患者随访107例,随访率84.3%.平均随访23(4～51)个月.9例术中术后发生并发症患者预后良好.术后患者1、3年总生存率为95.6%、95.6%,无瘤生存率95.8%、95.8%,肿瘤特异生存率96.8%、96.8%.pT1～T2者3年总生存率,肿瘤特异生存率和无瘤生存率分别为97.1%、98.6%、98.6%;pT3a者分别为90.2%、85.6%、90.2%.pT1～T2与pT3a患者肿瘤特异生存率和无瘤生存率比较差异有统计学意义(P<0.05).术后患者生活质量评分≥80分者占91.6%(98/107). 结论 后腹腔镜下根治性肾切除术安全有效;并发症发生率低、预后好;患者术后生存率较高,其生存率与肿瘤病理分期相关;患者术后有较好的生活质量.

Follow-up of 127 cases after laparoscopic radical nephrectomy

Objective To discuss the curative effect and the prognosis of patients with renal cell carcinoma after laparoscopic radical nephrectomy. Methods One hundred and twenty-seven cases of renal cell carcinoma treated with laparoscopic radical nephrectomy between October 2002 and Decem-ber 2006 were reviewed. The perioperative complications and postoperative renal function were recor-ded and analyzed. Post-operative 1-year and 3-year actuarial survival rates, disease-free survival rates and tumor-specific survival rates were caculated respectively with Kaplan-Meier analysis. Quality of life(QOL) was compared before and after surgery by Karnofsky Performance Status measuring scale. Results Among the 127 patients, 107 cases were followed up of mean 23 months (4-51 months). 1-year and 3-year actuarial survival rates, disease-free survival rates and tumor-specific survival rateswere 95.6%, 95.6%; 95.8%, 95.8% and 96.8%, 96.8%, respectively. 3-year actuarial survival rate, disease-free survival rate and tumor-specific survival rate were 97.1%,98.6%, 98.6% in pT1-2 tumors, and were 90.2%, 85.6%, 90.2%in pT3a, tumors. Disease-free survival rate and tumor-spe-cific survival rate had significant differences between patients in stage pT1-2 and patients in stagepTa3a.91.6% of the patients scored the post-operative QOL above 80 by Karnofsky Performance Sta-tus measuring scale. Conclusions Patients who underwent laparoscopic radical nephrectomy have high survival rate, low complication incidence and good QOL. Post-operative survival rate is correlated with pathologic stage.