保留肾单位手术与根治性肾切除术治疗T1a期肾癌疗效比较

目的比较根治性肾切除术和保留肾单位手术两种术式治疗T1a肾癌的远期疗效。方法 T1a期肾癌病人共78例,40例为根治性肾切除术组,38例为保留肾单位手术组,通过比较两组患者住院时间、出血量、手术时间术中及术后并发症、5年生存率来评估手术期间以及手术前后肾功能、术后并发症、复发情况及5a生存率差异。结果 78例手术顺利。保留肾单位手术组和根治性肾切除术组平均手术时间分别为(95.8±14.6)min和(90.1±10.5)min;术后平均住院天数分别为(17.2±7.0)d和(15.5±10.1)d;术中失血量分别为(124.4±34.7)mL和(114.5±26.3)mL;术前肌酐分别为(82.3±13.5)μmol/L和(85.7±17.6)μmol/L,术后24h肌酐分别为(90.4±37.5)μmol/L和(105.8±46.7)μmol/L,术后5a肌酐水平分别为(86.6±28.3)μmol/L和(142.2±42.7)μmol/L;78例随访(52.7±8.7)个月,保留肾单位组5a生存率97.5%,肿瘤复发率2.5%;根治性肾切除术组5a生存率为97.4%,肿瘤复发率2.6%。两组平均手术时间、术中失血量、术后平均住院天数、肿瘤复发率、5a生存率差异均无统计学意义(P>0.05)。保留肾单位手术组术前,术后24h及术后5a3次肌酐值比较差异无统计学意义(P>0.05)。根治性肾切除术(RN)组术前,术后24h及术后5a3次肌酐值比较差异有统计学意义(P<0.05)。结论与肾癌根治术治疗T1a期肾细胞癌相比较,保留肾单位手术具有安全、局部复发率低、更好地保留功能性肾单位等优点,两种术式远期临床效果无明显差异。

Comparison of curative effect of radical nephrectomy and nephron sparing surgery for T1a renal carcinoma

Objective To compare the long-term effect of nephron-sparing surgery(NSS) and radical nephrectomy(RN) on T1a renal cell carcinoma.Methods A retrospective analysis of 38 T1a cases of NSS,RN in patients with clinical data of 40 T1a patients.The patients were divided into radical group and NSS group based on surgical approach.The duration of operation,hospital days,blood loss,postoperative complications,local recurrence and 5 year survival rate were recorded and analyzed.Results Seventy eight were with smooth operation.The mean duration of operation for NSS group and RN group were(95.8±14.6) minutes and(90.1±10.5) minutes;the average postoperative hospitalization were(17.2±7.0) d and(15.5±10.1) d;blood loss were(124.4±34.7) mL and(114.5±26.3) mL;and the average preoperative SCr were(82.3±13.5) μmol/L and(85.7±17.6) μmol/L,and the average postoperative 24 hours SCr were(90.4±37.5) μmol/L and(105.8±46.7) μmol/L,and the average postoperative 5 years SCr were(86.6±28.3) μmol/L and(142.2±42.7) μmol/L.All patients were successfully followed up for(52.7±8.7) months.In NSS group,five-year survival rate was 97.5% and five-year tumor recurrence rate was 2.5%.In RN group,five-year survival rate was 97.4% and five-year tumor recurrence rate was 2.6%.There was no significant differences for the mean duration of operation,the average hospitalization,blood loss,five-year survival rate and five-year tumor recurrence rate between two teams(P>0.05).It had no differences(P>0.05) for the average preoperative SCr,postoperative 24 hours SCr and postoperative 5 years SCr in NSS group.There were obviously differences(P<0.05) for the average preoperative SCr,postoperative 24 hours SCr and postoperative 5 years SCr in RN group.Conclusion Compare with RN,NSS surgery for T1a renal cell carcinoma is a safe,effective,with lower local recurrence rate,better retention of the functional advantages of renal units.