后腹腔镜下肾部分切除与根治性肾切除治疗T1期肾癌的疗效分析

目的比较后腹腔镜下肾部分切除（LPN）与根治性肾切除（LRN）治疗T₁期肾癌的疗效，并分析影响后腹腔镜中转开腹的危险因素。 方法纳入解放军第九八三医院198例T₁期肾癌患者为研究对象。根据手术方式，将患者分为LPN组102例，LRN组96例。收集临床资料并随访，比较两种手术方式的差异。根据术中是否中转开腹，将患者分为中转开腹组17例，非中转开腹组181例。分析影响手术中转开腹的危险因素。 结果（1）两组患者均以透明细胞癌为主要病理类型，每组均有2例T_1bN₀M₀分期患者。与LRN组患者相比，LPN组患者的手术时间明显较长，术中出血量较多，但术后排气时间较短，引流量较少，术后VAS评分也更低（P<0.05）。（2）在术后1个月、3个月、6个月、12个月四个时间点，LRN组的血肌酐水平始终显著高于LNSS组（P<0.05）。（3）LPN组与LRN组的总体生存率（OS）为95.1%、96.9%，无病生存率（DFS）为91.2%、93.8%。Log-rank检验发现，两组患者DFS（P=0.633）、OS（P=0.600）的差异无统计学意义。（4）多因素分析发现，患者BMI、腹部手术史、肿瘤直径是影响后腹腔镜治疗T₁期肾癌中转开腹的独立性危险因素（P<0.05）。 结论与LRN组比较，LPN能在取得相似远期疗效的基础上，更好地保护患者肾功能。对可能导致术中中转开腹的危险因素，如患者术前BMI、腹部手术史、肿瘤直径等因素，应予以更充分评估。

Comparison of retroperitoneal laparoscopic partial nephrectomy and radical nephrectomy for stage T1 renal cell carcinoma

ObjectiveTo compare the efficacy of laparoscopic partial nephrectomy (LPN) and laparoscopic radical nephrectomy (LRN) in the treatment of stage T₁ renal cell carcinoma, and to analyze the risk factors of conversion to open surgery. Methods198 patients in the 983 Hospital were collected for the study. To compare the differences between the two surgical methods, the 102 patients were divided into LPN group and 96 patients into LRN group. To analyze the related risk factors, 17 patients were divided into open surgery group and 181 patients into non-open surgery group. Results(1) Compared with LRN group, LPN group had longer operation time and more blood loss, but shorter exhaust time, less drainage and lower VAS score (P<0.05). (2) There were 2 patients with T_1bN₀M₀ stage in each group. The serum creatinine level in LRN group was significantly higher than that in LPN group at 1, 3, 6 and 12 months after operation (P<0.05). (3) Overall survial (OS) of LPN group and LRN group were 95.1% and 96.9%, Disease free survival (DFS) were 91.2% and 93.8% respectively. There was no significant difference in DFS and OS between the two groups. (4) BMI, history of abdominal surgery and diameter of tumors were independent risk factors for conversion to open surgery (P<0.05). ConclusionCompared with LRN group, LPN can protect renal function better. Risk factors that may lead to conversion to open surgery should be more fully assessed.