肾细胞癌患者行保留肾单位手术与根治性手术的效果及生活质量比较

目的 分析保留肾单位手术(NSS)与腹腔镜根治性肾切除术(RPRN)治疗肾细胞癌的效果及对生活质量的影响.方法 选取2012年9月—2015年1月就诊的80例肾细胞癌患者,根据手术治疗方法分为RPRN组(n=40)、NSS组(n=40).统计两组手术时间、出血量、引流时间、术后下床时间、住院时间,检测术前、术后1年和2年的血肌酐水平,分析术后1年、2年的生存率与生活质量,生活质量采用中文版健康调查简表评分(SF-36)评估.结果NSS组下床时间、住院时间较RPRN组短(P<0.05).术后1年和2年,NSS组血肌酐水平低于RPRN组(P<0.01).RPRN组术前、术后1年、2年血清肌酐水平依次显著升高(P<0.05).两组术后1年和2年生存率比较差异无统计学意义(P>0.05).两组术后2年SF-36评分中生理功能、生理职能、情感职能和总体健康评分均较术后1年明显升高(P<0.05).术后1年、2年,NSS组SF-36评分中生理功能、生理职能、精神健康、情感职能和总体健康评分均显著高于RPRN组(P<0.05).结论 NSS治疗肾细胞癌在改善手术疗效、提高生存率、促进术后恢复等方面与RPRN类似,尤其能有效保护肾功能和提高术后生活质量.

Comparison of Efficacy and Life Quality between Nephron Sparing Surgery and Retroperitoneoscopic Radical Nephrectomy in Treatment of Patients with Renal Cell Carcinoma

Objective To analyze effects of nephron sparing surgery ( NSS) and retroperitoneoscopic radical ne-phrectomy ( RPRN) in treatment of patients with renal cell carcinoma and influences on quality of life. Methods A total of 80 patients with renal cell carcinoma during September 2012 and January 2015 were divided into RPRN group (n=40) and NSS group ( n=40 ) according to different surgical treatments. In two groups, operation time, bleeding volume, drainage time, postoperative time of getting out of bed and hospital stay were recorded;serum creatinine levels in preoper-ative and postoperative 1 year and 2 years were detected;survival rates and quality of life in postoperative 1 year and 2 years were analyzed, and postoperative quality of life was evaluated by Chinese version of Shot Form 36 Health Survey Questionnaire (SF-36). Results In NSS group, postoperative time of getting out of bed and hospital stay were shorter, ( P<0. 05 ) , while serum creatinine levels in postoperative 1 year and 2 years were significantly lower than those in RPRN group (P<0. 01). Serum creatinine levels were significantly increased in turn in preoperative and postoperative 1 year and 2 years in RPRN group ( P<0. 05 ) . There were no significant differences in survival rates in postoperative 1 year and 2 years between the two groups (P>0. 05). Scores of physiologic function, physical role, emotional function and general health by SF-36 evaluation in postoperative 2 years were significantly higher than those in postoperative 1 year in two groups (P<0. 05). Scores of physiologic function, physical role, mental health, emotional function and general health by SF-36 evaluation in postoperative 1 year and 2 years in NSS group were significantly higher than those in RPRN group (P<0. 05). Conclusion NSS in treatment of patients with renal cell carcinoma can achieve similar effects with those by RPRN such as improving surgical efficacy and survival rate and promoting postoperative recovery, and it can ef-fectively protect renal function and improve postoperative quality of life.