后腹腔镜手术与开放手术治疗T<sub>2</sub>期及以上肾癌的对照研究

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摘要目的:比较后腹腔镜手术与开放性手术治疗T₂期及以上肾癌(肿瘤体积>7 cm)的疗效。方法:回顾性分析2012年1月~2015年1月经手术治疗的57例大体积肾癌(>7 cm)患者的临床资料。男34例,女23例,年龄44~72岁,平均(58.2±7.0)岁。肿瘤直径7.0~12.2 cm,平均(8.8±1.2)cm。肿瘤位于左侧30例,右侧27例。术前临床分期T₂~T₃期。所有患者均行根治性肾切除术,26例采用后腹腔镜手术(研究组),31例采用开放性手术(对照组)。排除下腔静脉瘤栓形成,术前淋巴结及远处转移、多发肿瘤患者。两组患者的年龄、性别、肿瘤大小和位置等临床资料比较均差异无统计学意义(P>0.05)。比较两组手术时间、出血量、输血率、术后并发症发生率、术后住院时间、随访情况等。结果:研究组1例中转开放手术。研究组与对照组的手术时间分别为(115.0±23.1)min和(132.2±28.4)min,术后排气时间分别为(1.7±0.6)d和(2.3±0.6)d,均差异有统计学意义(P<0.05)。两组在术中出血量、输血率、术后并发症发生率、术后住院时间等方面比较均差异无统计学意义(P>0.05)。术后病理均诊断为肾透明细胞癌,病理分期研究组T₂期21例,T_3a期5例;对照组T₂期25例,T_3a期6例。术后随访4~40个月,平均19个月,中位时间20个月。研究组平均生存期为17.5个月,对照组为18.2个月;研究组无疾病进展生存期平均为15.5个月,对照组为16.9个月。Cox风险分析结果显示,在年龄、性别、手术方式、肿瘤分期四个因素,只有肿瘤分期是总体生存期(P=0.018)和无疾病进展生存期(P=0.020)的独立危险因素。手术方式不是独立危险因素(P=0.312;P=0.331)。结论:后腹腔镜手术治疗大体积肾癌安全、可行、有效。后腹腔镜手术较开放手术手术时间短、术后恢复快。手术方式不是患者总体生存期和无疾病生存期的独立危险因素。

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	侯毅
	陈晓亮
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	孔祥波
	王志新

关键词 ：肾癌, 后腹腔镜手术, 开放手术

Abstract：Objective: To compare the efficacy of laparoscopic surgery vs. open surgery in the treatment of T₂ and above renal cell carcinoma (>7 cm). Methods: From Jan. 2012 to Jan. 2015, the clinical data of 57 patients undergoing nephrectomy in our hospital were analyzed retrospectively. There were 34 males and 23 females, with age ranging from 44 to 72 (mean 58.2±7.0) years old. The size of tumor was between 7.0-12.2 cm (mean 8.8±1.2 cm). Left renal tumor was found in 30 patients and right renal tumor in 27 patients. Clinical stages of tumors were T₂ to T₃. All patients were subjected to the nephrectomy via the retroperitoneal approach in 26 cases (observation group) and open approach in 31 cases (control group). The exclusive criteria included inferior vena cava tumor thrombus, lymphatic or distant metastasis, mutiple tumors. There were no significant differences in the age, gender, tumor size and location between two groups (P>0.05). The perioperative indexes and oncological outcomes, such as operation time, blood loss, incidence of blood transfusion, postoperative hospital stay, complications and follow-up results, were collected and compared between two groups. Results: Conversion occurred in one case from observation group. Operative time in observation group was significantly shorter than that in control group (115.0±23.1 min vs. 132.2±28.4 min, P<0.05). Bowel function recovered more rapidly in observation group than in control group (1.7±0.6 d vs. 2.3±0.6 d,P<0.05). However, the estimated blood loss, the incidence of blood transfusion, the postoperative hospital stay and perioperative complications showed no significant difference between two groups (P>0.05). The histopathological examination confirmed renal clear cell carcinoma in all cases. In observation group there were 21 cases of T₂ stage and 5 cases of T_3a stage, and in control group there were 25 cases of T₂ stage and 6 cases of T_3a stage. The follow-up duration ranged from 4 to 40 months (mean 19 months). Mean overall survival was 17.5 months in observation group and 18.2 months in control group. Progression free survival time was 15.5 months in observation group and 16.9 months in control group. Cox survival analysis showed that only pre-operative stage of the tumor was independent risk factor for the survival time (P=0.018) and progression free survival time (P=0.020), while the operative approach was not the independent risk factor (P=0.312, 0.331). Conclusions: For large renal tumor(>7 cm) retroperitoneal laparoscopic radical nephrectomy was safe and feasible. Compared to the open approach, retroperitoneal approach costs less operative time and obtains rapid recovery. But the operation approach is not an independent risk factor for the survival time and progression free survival time.

Key words： kidney cancer retroperitoneal laparoscopic surgery open surgery

收稿日期: 2015-08-26

ZTFLH:

R737.11

通讯作者: 王志新 E-mail: hern.wang@aliyun.com

引用本文:

侯毅,陈晓亮,霍威,孔祥波,王志新. 后腹腔镜手术与开放手术治疗T₂期及以上肾癌的对照研究[J]. 微创泌尿外科杂志, 2015, 4(6): 321-324.
Hou Yi , Chen Xiaoliang , Huo Wei , Kong Xiangbo , Wang Zhixin. Comparison between laparoscopic and open surgical treatment for T₂ renal cell carcinoma. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2015, 4(6): 321-324.

链接本文:

http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract823.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2015/V4/I6/321

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