摘要
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cT_(1)~T_(2)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cT_(1)~T_(2)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。
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 cT_(1)-T_(2) 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.
作者
苏伟
朱鸣阳
SU Wei;ZHU Mingyang(Urology Surgery,Characteristics Medical Center of Chinese People’s Armed Police Force,Tianjin 300162,China)
出处
《武警医学》
CAS
2023年第11期921-925,共5页
Medical Journal of the Chinese People's Armed Police Force
