肾细胞癌手术切除方式变更的人群特征及其影响

目的 肾细胞癌手术治疗现仍为临床治疗的首选方法.近年来,肾部分切除术的适应证不断拓广,在保证疗效的同时保护肾脏功能,提高了肾肿瘤患者的生存质量.但是,临床上仍有相当一部分患者在手术过程中会出现部分切除术改根治切除术的情况.方法 收集自2012年1月至2015年6月于本院泌尿外科因肾实质性肿瘤行手术治疗的患者临床资料,并随访其手术后相关情况.通过多种方法比较,来分析出现手术切除方式变更的人群特征,以及手术切除方式变更对术后恢复的影响.结果 年龄、性别、手术时间、术中出血量、手术术式等相关因素在手术切除方式变更及未变更人群中并不存在明显差异.术前TNM分期为T1 bN0M0的患者相较于其他分期患者更易出现手术方式变更.手术切除方式变更也并未对术后短期不适及长期不适产生明显影响.结论 术前T1 bN0M0分期患者人群更易出现术中手术切除方式变更.手术切除方式变更并不会对患者手术时间、术中出血量产生明显影响,也不会因此明显增加患者术后不适的可能性.在保证手术疗效的前提下,尝试部分肾切除术有助于提高患者生存质量;选择进行部分切除的患者中应当尤为关注T1bN0M0期患者,充分做好手术切除方式变更的准备.

Characteristics and effects of the change in surgical removal of renal cell carcinoma

Objectives Surgical treatment is still the first choice for renal cell carcinoma.In recent years,the indication of the partial nephrectomy has been extended,of which could protect the renal function,and improve the quality of life of patients as well.However,there is still a considerable part of the patients,who would have the change of surgical removal method,partial nephrectomy to radical nephrectomy,in the operation process.Methods The clinical and following-up data of patients with renal cell carcinoma,who had surgical treatment from January 2012 to June 2015 in our hospital,were collected.By comparison of various methods,the characteristics of the people who have changed the way of surgical resection and the effect of the change on the recovery after operation were analyzed.Results Age,sex,operation time,blood loss,surgical operation and other related factors were not significantly different between the population with the change of surgical removal method and that without the change.The preoperative TNM staging was more prone to surgical changes in patients with T1 bN0M0 than in other staging patients.The change of surgical resection did not significantly affecte the short-term discomfort and long-term discomfort.Conclusions The preoperative T1 bN0M0staging patients is more prone to have the change of surgical resection method.The change of surgical removal method will not have significant impact on the patient's operation time,intraoperative blood loss,and the likelihood of postoperative discomfort.In the premise of ensuring the efficacy of the surgery,the choice of partial nephrectomy would be helpful in keeping the quality of life.And for all those who would have the operation of partial nephrectomy,T1bN0M0 staging patients should be particularly concerned.