摘要
目的比较肾癌患者选择保留肾单位手术(nephron-sparing surgery,NSS)与根治性肾切除手术(radical nephrectomy,RN)的一般临床特征、诊治过程、术后患者恢复情况、手术效果。方法回顾性分析我科2008年9月至2013年9月共收治的463例肾癌患者临床资料,根据影像学资料及术后病理结果,选取按照2010年AJCC肾癌分期标准为Ⅰ期的单侧肾癌患者253例,分为NSS组和RN组,其中NSS组患者99例,男性65例,女性34例,年龄(56.70±13.59)岁,有临床症状19例,无临床症状的80例,术后病检为透明细胞癌的89例;RN组患者154例,男性98例,女性56例,年龄(57.64±12.39)岁,有临床症状70例,无临床症状的84例,术后病检为透明细胞癌的138例。比较采用NSS和RN 2种不同手术方式的患者一般临床资料、术中情况及术后随访情况。结果早期肾癌患者大多通过体检或者住院腹部B超首先发现,我院B超首先发现肾癌患者占76.28%。NSS组与RN组比较,患者年龄、肿瘤侧别、病理结果、术前肌酐、术后3个月肌酐、术后12个月肌酐、3年复发或转移情况及无瘤生存率差异无统计学意义(P>0.05),临床症状、术中出血、手术时间、术后24 h内肌酐差异有统计学意义(P<0.05),RN组具有更多临床症状患者(19例vs 70例,19.2%vs 45.5%),NSS组较RN组术中出血多(136.87 m L vs 100.26 m L),手术时间长(119.17 min vs 108.57 min),但术后对肾功能的影响小,术后局部复发(4例vs8例)与远处转移(4例vs 9例)无明显差异,无瘤生存率无明显差异(96.8%vs 95.9%)。结论 B超有利于早期肾癌的筛查,NSS对于T1期局限性肾癌患者不仅能够完整切除肿瘤,还能保留残肾及其功能,有利于术后生活质量以及肾功能恢复。
Objective To compare the clinical characteristics,operation effect and the recovery of patients after operation between cell carcinoma using nephron-sparing surgery（ NSS） and radical nephrectomy（ RN）. Methods Clinical data of 463 hospitalized patients with renal cell carcinoma admitted in our hospital from September 2008 to September 2013 were collected and retrospectively analyzed. According to the imaging data and postoperative pathological results in 2010 AJCC kidney cancer standard stage,253 patients of the cohort were defined as unilateral renal cell carcinoma in stage 1,and they were further divided into NSS group（ n = 99） and RN group（ n = 154）. In the former group,there were 65 males and 34 females with an average age of 56. 70 ± 13. 59,and 19 with clinical symptoms and 80 without,and 89 cases patients was pathologically identified as clear cell carcinoma. While,the RN group had 154 patients including 98 males and 56 females,at an average age of 57. 64 ± 12. 39,70 with clinical symptoms and 84 without,and 138 of them was clear cell carcinoma. Clinical data,operation situation,and postoperative condition during follow-up were compared between the 2 groups of patients undergoing different surgical mode. Results Early renal cell carcinoma was commonly with no obvious clinical symptoms,and usually firstly diagnosed by B-ultrasound imaging during the period of hospitalization or physical examination. In this cohort,the patients suffering from renal cell carcinoma firstly diagnosed by B ultrasonography accounted for 76. 28%. There was no significant difference between the NSS group and RN group in the aspects of age,affected side of tumor,pathological results,recurrence,metastasis and disease-free survival rate at 3 years,and serum levels of creatinine preoperatively and 3 and 12 months postoperatively（ P 〉 0. 05）. But significant differences were found in the clinical symptoms,serum creatinine in 24 h postoperatively,bleeding volume during operation,and operation time between the 2 groups（ P 〈 0. 05）. RN group had more patients with clinical symptoms（ 19 vs 70,19. 2% vs 45. 5%）. The NSS group had larger amount of intraoperative bleeding than the RN group（ 136. 87 vs 100. 26 m L）,longer operation time（ 119. 17 vs 108. 57 min）,but slightly renal damage. The local recurrence（ 4 vs 8 cases） and distant metastasis（ 4 vs 9 cases） had no significant difference,nor the disease-free survival rate（ 96. 8% vs95. 9%） between the 2 groups. Conclusion B-ultrasonography is helpful to early kidney cancer screening.Evidence indicates that nephron-sparing surgery is better than radical nephrectomy. And the former approach can maximally preserve the nephron and its function,which helps to improve the post-operative quality of life.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2014年第23期2404-2407,共4页
Journal of Third Military Medical University
关键词
肾癌
根治性肾切除术
保留肾单位手术
手术效果
renal carcinoma； radical nephrectomy； nephron-sparing surgery； operation effect
