腹腔镜与开放保留肾单位手术治疗T1a期肾癌的临床疗效比较

目的比较腹腔镜和开放保留肾单位手术治疗T1a期肾癌的手术特点和临床疗效。方法回顾性分析115例同一术者行保留肾单位手术治疗T1a期肾癌患者临床资料,其中腹腔镜手术55例,开放手术60例。比较两种手术方法的手术时间、肾脏缺血时间、失血量、住院时间、并发症及肾功能恢复的差别。结果腹腔镜组手术时间为165～255min,平均(212.0±45.3)min;开放组为95～138min,平均(140.7±25.6)min,差异有统计学意义(P=0.000)。腹腔镜组肾缺血时间为25～45min,平均(41.3±5.4)min;开放组为15～26min,平均(24.4±5.7)min,差异有统计学意义(P=0.000)。腹腔镜组失血量为100～250ml,平均(168.8±51.7)ml;开放组为200～550ml,平均(285.3±77.9)ml,差异有统计学意义(P=0.000)。腹腔镜组术后住院天数为6～10d,平均(6.2±0.5)d;开放组为7～15d,平均(7.1±0.6)d,差异有统计学意义(P=0.001)。腹腔镜组、开放组手术并发症发生率分别为7.3%(4/55)、18.3%(11/60),差异有统计学意义(P=0.044)。术后中位随访时间18(6～32)个月,除失访和其他原因死亡外,无一例出现肿瘤复发和远处转移,两组间双肾总肾小球滤过率(GFR)变化差异无统计学意义(P=0.105)。结论腹腔镜保留肾单位手术较开放手术具有失血量少、术后住院时间短、手术并发症少等优势,且手术时间和肾缺血时间的延长并未明显影响术后肾功能恢复和远期预后。

Laparoscopic and open nephron-sparing surgery for T1a stage renal cell carcinoma: a comparison of clinical outcomes

Objective To compare the surgical characteristics and clinical outcomes of laparoscopic nephron-sparing surgery (LNSS) and open nephron-sparing surgery (NSS) for T1a stage renal cell carcinoma. MethodsWe retrospectively analyzed the clinical data of 115 patients with T1a stage renal cell carcinoma, who were treated with NSS. Fifty-five patients received LNSS and 60 received open NSS. The operation time, renal ischemia time, blood loss, hospital stay, complications and renal function recovery were compared between the two groups. ResultsThe mean operation time periods in LNSS and open NSS group were 165-255 min (a mean of [212.0±45.3] min) and 95-138 min (a mean of [140.7±25.6] min, P=0.000), the renal ischemia time periods were 25-45 min (a mean of [41.3±5.4] min) and 15-26 min ([24.4±5.7] min, P=0.000), the blood losses were 100-250 ml (a mean of [168.8±51.7] ml) and 200-550 (a mean of [285.3±77.9] ml, P=0.000), the periods of hospital stay were 6-10 d (a mean of [6.2±0.5] d) and 7-15 d(a mean of [7.1±0.6] d, P=0.001), and the complication rates were 7.3%(4/55) and 18.3%(11/60, P=0.044), respectively. The patients were followed up for a median of 18(6-32) months. Except for the cases who were lost to follow-up or dead because of other reasons, there were no local recurrence or distant metastasis. The postoperative double glomerular filtration rates were not statistically different between the two groups(P=0.105).ConclusionLNSS has less blood loss, shorter hospital stay and less complication than open NSS, and longer operation time and renal ischemia time have little influence on renal function and long-term prognosis.