腹腔镜肾肿瘤剜除术治疗T1aN0M0期肾癌

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摘要目的:总结腹腔镜肾肿瘤剜除术治疗T_1aN₀M₀期肾癌的临床经验。方法:回顾性分析2006年10月~2012年10月接受腹腔镜保留肾单位手术(LNSS)的179例T_1aN₀M₀期肾癌患者临床资料,按手术方式分为A、B两组,A组为接受腹腔镜肾肿瘤剜除术(LTE)患者,共94例,B组为接受标准腹腔镜肾部分切除术(LPN)患者,共85例,对两组患者基本资料、围手术期情况、组织病理学结果及随访结果进行统计学分析。结果:A组、B组的手术时间、肾动脉阻断率及阻断时间之间比较差异无统计学意义(P>0.05)。A组术中失血量及输血率、术后并发症发生率及术后住院时间均较B组下降,差异有统计学意义(P<0.05)。术后病理证实A、B组切缘阳性分别有1例(1.1%)、3例(3.5%),癌组织累及但未穿透假包膜分别有22例(23.4%)、27例(31.8%),均差别无统计学意义(P>0.05)。平均随访时间(33.5±20.9)个月,两组患者术后12个月eGFR水平较术前差异无统计学意义。A组1例(1.1%)出现同侧肾脏异位复发,1例(1.1%)出现肺转移;B组原位复发、同侧肾脏异位复发、肺转移各1例;两组间复发率、转移率差异无统计学意义(P>0.05)。结论:LTE可获得与LPN相同的肿瘤学效果,有利于保留更多的正常肾组织,且并发症发生率较低,是治疗T_1aN₀M₀期肾癌有效的手段。

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	邓永明
	赵晓智
	叶长晓
	张青
	李笑弓
	张古田
	甘卫东
	郭宏骞

关键词 ：腹腔镜技术, 肾细胞癌, 保留肾单位手术, 肿瘤剜除术

Abstract：Objective: To determine the feasibility and efficacy of laparoscopic tumor enucleation (LTE) for T_1aN₀M₀ renal cell carcinoma (RCC). Methods: From October 2006 to October 2012, a total of 179 patients who underwent laparoscopic nephron sparing surgery for T_1aN₀M₀ RCC were divided into two groups according to the theray procedures. The patients in group A, including 94 patients, were treated by LTE, and those in group B, including 85 patients, were subjected to laparoscopic partial nephrectomy (LPN). The efficacy was evaluated by comparing demographic, intraoperative, postoperative, histopathologic and follow-up data. Results: There were no significant differences in age, gender, the greatest tumor diameter, the mean operation time, the rate of clamping the renal artery, the warm ischemia time between two groups (P>0.05). The intraoperative blood loss, the rate of intraoperative blood transfusion, the rate of complications and the hospital stay after operation in group A were significantly decreased as compared with group B (P<0.05). One patient in group A and 3 patients in group B had positive surgical margins, and 22 patients in group A and 27 patients in group B had pseudocapsule with signs of penetration (P>0.05). During the postoperative follow-up period with a mean of (33.5±20.9) months, local recurrence alone elsewhere in the kidney was observed in 1 patient of the two groups respectively. One patient had local recurrence while another one had single lung metastasis in group B. There were no significant differences in the recurrence rate and transfer rate between the two groups (P>0.05). Conclusions: LTE has the similar oncologic outcome compared to LPN for T_1aN₀M₀ RCC, with a better reserved renal function, and decreased rate of complications.

Key words： laparoscopy renal cell carcinoma nephron-sparing surgery tumor enucleation

收稿日期: 2014-07-27

ZTFLH:

R737.1

通讯作者: 郭宏骞 E-mail: dr.ghq@163.com

引用本文:

邓永明,赵晓智,叶长晓,张青,李笑弓,张古田,甘卫东,郭宏骞. 腹腔镜肾肿瘤剜除术治疗T_1aN₀M₀期肾癌[J]. 微创泌尿外科杂志, 2015, 4(1): 11-15.
Deng Yongming, Zhao Xiaozhi, Ye Changxiao, Zhang Qing,Li Xiaogong, Zhang Gutian, Gan Weidong, Guo Hongqian. Laparoscopic tumor enucleation for renal cell carcinoma of T_1aN₀M₀ stage: the experience in a single centre. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2015, 4(1): 11-15.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract737.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2015/V4/I1/11

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