目的 比较后腹腔镜下肾部分切除术和根治性肾切除术的肾肿瘤患者围手术期指标、肾功能指标及预后情况。方法 选取武警特色医学中心2019-01至2022-04收治的cT1~T2期肾肿瘤患者(≥65岁)118例,根据患者意愿分别行后腹腔镜下根治性肾切除术(对照组62例)和肾部分切除术(观察组56例)。比较两组手术指标、炎症因子、细胞免疫指标、肾功能指标,以及术后并发症和预后情况。结果 观察组肿瘤直径小,R.E.N.A.L.评分低,手术时间长,与对照组比较,差异有统计学意义(P<0.05)。术前和术后24 h两组间炎症因子和细胞免疫指标差异均无统计学意义(P>0.05)。术后,观察组血尿素氮(BUN)、血肌酐(SCR)水平降低,估算肾小球滤过率(eGFR)升高,与对照组比较,差异均有统计学意义(P<0.05)。末次随访时观察组eGFR降低百分比(10.24%)低于对照组(33.81%)。观察组心血管事件(1.79%)和病死率(1.79%)均低于对照组(8.06%,6.45%),差异均有统计学意义(P<0.05)。结论 相比后腹腔镜下根治性肾切除术,后腹腔镜下肾部分切除术治疗≥65岁的cT1~T2期肾肿瘤患者未增加围手术期风险,并通过保留更多肾功能而改善患者预后。
Abstract
Objective To compare perioperative indexes, renal function indexes and prognosis of patients with renal tumor after retrolaparoscopic partial nephrectomy and radical nephrectomy. Methods A total of 118 patients with stage cT1-T2 renal tumor admitted to Characteristics Medical Center of Chinese People’s Armed Police Force from January 2019 to April 2022 were selected to undergo radical laparoscopic nephrectomy (62 cases in the control group) and partial nephrectomy (56 cases in the observation group) according to their wishes. The indexes of operation, inflammatory factors, cellular immunity, renal function, postoperative complications and prognosis were compared between the two groups. Results The observation group had smaller tumor diameter, lower R.E.N.A.L. score and longer operation time, and the differences were statistically significant compared with the control group (P<0.05).There was no statistically significant difference in inflammatory cytokines or cellular immune indexes between the two groups before and 24 h after surgery (P>0.05).After surgery, the levels of BUN and SCR decreased and eGFR increased in the observation group, with statistically significant differences compared with the control group (P<0.05).At the last follow-up, the percentage of eGFR decrease in the observation group (10.24%) was lower than that in the control group (33.81%).The incidence of cardiovascular events and deaths in the observation group was lower than that in the control group, and the difference was statistically significant (P<0.05). Conclusions Compared with retrolaparoscopic radical nephrectomy, retrolaparoscopic partial nephrectomy does not increase perioperative risk in patients with renal tumor and improve prognosis by preserving more renal function.
关键词
后腹腔镜下根治性肾切除术 /
后腹腔镜下肾部分切除术 /
肾肿瘤 /
围手术期 /
肾功能
Key words
retrolaparoscopic radical nephrectomy /
retrolaparoscopic partial nephrectomy /
renal tumor /
perioperative /
renal function
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Mier J W. The tumor microenvironment in renal cell cancer[J].Curr Opin Oncol, 2019, 31(3): 194-199.
[2] Yang B, Ma L L, Qiu M, et al. A novel nephrometry scoring system for predicting peri-operative outcomes of retroperitoneal laparoscopic partial nephrectomy[J]. Chin Med J (Engl), 2020, 133(5): 577-582.
[3] Zhang Y,Yang J,Zhang M,et al.Thyroid follicular carcinoma like renal tumor: a case report and literature review[J]. Medicine (Baltimore), 2018, 97(21): e10815.
[4] Yuan B, Wang Y, Gao J, et al.Lower pole approach in retroperitoneal laparoscopic radical nephrectomy: a new approach for the management of renal vascular pedicle[J]. World J Surg Oncol, 2018, 16(1): 31.
[5] Tanaka R,Tomiyama E,Sekii Y,et al.Disturbance of consciousness in a patient with an indwelling lumbar-peritoneal shunt following retroperitoneal laparoscopic radical right nephrectomy: a case report[J]. Hinyokika Kiyo, 2019, 65(7): 287-289.
[6] 高锡强.根治性肾切除术与保留肾单位的肾部分切除术治疗肾癌的临床疗效对比[J].当代医学, 2019, 25(3): 112-114.
[7] 杨前进,周晓晓,侯莉莉,等.后腹腔镜保留肾单位术和根治性肾切除术治疗局限性T1b、T2a期肾癌效果分析[J].河南外科学杂志, 2019, 25(3): 60-62.
[8] Huang Y S,Chin W C, Guilleminault C,et al. Inflammatory factors: nonobese pediatric obstructive sleep apnea and adenotonsillectomy[J]. J Clin Med, 2020, 9(4): 1028.
[9] Qin F,Lv Q,Hong W,et al.Association between CD4/CD8 ratio recovery and chronic kidney disease among human immunodeficiency virus-Infected patients receiving antiretroviral therapy: a 17-year observational cohort study[J]. Front Microbiol, 2022, 13: 827689.
[10] Zhang N,Liu J,Qiu Z,et al.Shenfu injection for improving cellular immunity and clinical outcome in patients with sepsis or septic shock[J]. Am J Emerg Med, 2017, 35(1): 1-6.
[11] 栗 恒,李宏彬,夏 钢,等.传统开放性肾癌根治性切除术与后腹腔镜肾癌根治性切除术对肾癌患者的临床疗效及对肾功能的影响[J].癌症进展, 2019, 17(14): 1679-1682.
[12] Danilovic A,Ferreira T A C,Maia G V A,et al.Predictors of surgical complications of nephrectomy for urolithiasis[J].Int Braz J Urol, 2019, 45(1): 100-107.
[13] 董 毅,王 正,王 辉,等.肾部分切除术与根治性肾切除术治疗老年cT1～2期肾肿瘤围手术期指标及肾功能随访分析[J].中华泌尿外科杂志, 2019, 40(5): 351-355.
[14] Smith M, Herrington W G, Weldegiorgis M,et al.Change in albuminuria and risk of renal and cardiovascular outcomes: natural variation should be taken into account[J]. Kidney Int Rep, 2018, 3(4): 939-949.
[15] Kim B S,Kim T H,Oh J H,et al.Association between preoperative high sensitive troponin Ⅰ levels and cardiovascular events after hip fracture surgery in the elderly[J]. J Geriatr Cardiol,2018,15(3):215-221.
PDF(1296 KB)
