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目的:探讨射频辅助腹腔镜肾部分切除术治疗T1期肾癌的安全性和有效性。方法:回顾性分析2010年8月~2012年8月应用射频辅助腹腔镜肾部分切除术(RFA-LPN)与腹腔镜下肾部分切除术(LPN)治疗106例T1期肾癌患者的围手术期、随访复查的临床资料,其中RFA-LPN组52例患者,男34例,女18例;平均年龄(55.3±10.2)岁,肿瘤平均大小(3.04±0.97)cm。LPN组54例患者,男37例,女17例,平均年龄(52.4±10.1)岁,肿瘤平均大小(2.90±0.90)cm。术前检查明确肾脏占位诊断、排除远处转移;术后定期复查CT、血肌酐并计算肾小球滤过率(eGFR),评价分侧肾脏功能变化和肾肿瘤治疗疗效。结果:所有患者手术经腹腔镜顺利完成,无中转开放。LPN组和RFA-LPN组平均手术时间分别为(111.0±28.2)min和(131.0±29.6)min。LPN组均行肾动脉阻断,平均阻断时间为(23.9±6.3)min,RFA-LPN组共有11例患者行肾动脉阻断,阻断比例为21.1%,平均阻断时间为(20.1±5.7)min。术中平均出血量分别为(264.0±85.1)ml和(213.8±91.8)ml。术后平均住院天数分别为(8.6±2.0)d和(7.6±2.1)d。术后并发症LPN组术后总共出现8例并发症(14.8%),其中Ⅰ级并发症5例,Ⅱ级并发症2例。Ⅲ级并发症1例。RFA-LPN组术后总共出现9例并发症(17.3%),其中Ⅰ级并发症4例,Ⅱ级并发症3例。Ⅲ级并发症2例。组间比较均差异无统计学意义(P>0.05)。术后平均随访分别为(24.5±9.8)和(21.3±5.7)个月,所有患者未见肿瘤复发及转移。LPN组手术前后肌酐及eGFR分别为(78.3±8.5)μmol/L和(79.5±7.7)μmol/L,(82.7±8.5)ml·min-1·1.73m-2和(81.1±7.8)ml·min-1·1.73m-2。差异无统计学意义(P>0.05)。RFA-LPN组LPN组手术前后肌酐及eGFR分别为(72.9±9.5)μmol/L和(76.1±8.9)μmol/L,(73.4±9.3)ml·min-1·1.73m-2和(78.2±9.4)ml·min-1·1.73m-2。差异无统计学意义(P>0.05)。结论:与LPN比较,RFA-LPN治疗T1期肾癌同样安全、有效,可以保留肾脏功能,对于RFA-LPN的选择应严格遵循手术适应证。
Objective: To investigate the safety and effectiveness of radiofrequency assisted laparoscopic partial nephrectomy in the treatment of T1 stage renal cell carcinoma. Methods: The clinical data of 106 patients with T1 stage renal cell carcinoma treated by radiofrequency assisted laparoscopic partial nephrectomy (RFA-LPN) and laparoscopic partial nephrectomy (LPN) from August 2010 to August 2012 were retrospectively analyzed. Among them, there were 52 males and 34 females and 18 females in the RFA-LPN group. The average age was (55.3 ± 10.2) years old and the average tumor size was (3.04 ± 0.97) cm. In the LPN group, 54 patients were male and 37 female, with a mean age of (52.4 ± 10.1) years and mean tumor size (2.90 ± 0.90) cm. Preoperative diagnosis of renal space-clear diagnosis, the exclusion of distant metastasis; regular postoperative CT, serum creatinine and calculated glomerular filtration rate (eGFR), evaluation of renal function and the efficacy of treatment of renal tumors. Results: Laparoscopic surgery was successfully performed in all patients without transit. Mean operative time was (111.0 ± 28.2) min and (131.0 ± 29.6) min in LPN group and RFA-LPN group respectively. In the LPN group, renal artery occlusion was performed. The mean occlusion time was (23.9 ± 6.3) min. In the RFA-LPN group, 11 patients underwent renal artery occlusion with a blocking rate of 21.1% and an average of 20.1 ± 5.7) min. The mean intraoperative blood loss was (264.0 ± 85.1) ml and (213.8 ± 91.8) ml, respectively. The average postoperative hospital stay was (8.6 ± 2.0) days and (7.6 ± 2.1) days, respectively. Postoperative complications A total of 8 cases of complications (14.8%) occurred in LPN group after operation, of which 5 cases were grade Ⅰ complications and 2 cases were grade Ⅱ complications. Ⅲ grade complications in 1 case. A total of 9 cases of complications (17.3%) occurred in RFA-LPN group, of which 4 cases were grade Ⅰ complications and 3 cases were grade Ⅱ complications. Grade Ⅲ complications in 2 cases. There was no significant difference between the two groups (P> 0.05). The average postoperative follow-up was (24.5 ± 9.8) and (21.3 ± 5.7) months, respectively. No recurrence or metastasis was found in all patients. The levels of creatinine and eGFR in the LPN group were (78.3 ± 8.5) μmol / L and (79.5 ± 7.7) μmol / L, (82.7 ± 8.5) ml · min -1 · 1.73m -2 and (81.1 ± 7.8) ml · min-1 · 1.73m-2. The difference was not statistically significant (P> 0.05). The creatinine and eGFR in the LPA group were (72.9 ± 9.5) μmol / L and (76.1 ± 8.9) μmol / L, (73.4 ± 9.3) ml · min-1 · 1.73m-2 and 9.4) ml · min-1 · 1.73m-2. The difference was not statistically significant (P> 0.05). Conclusion: Compared with LPN, RFA-LPN is equally safe and effective in treating stage T1 renal cancer, and can retain renal function. The choice of RFA-LPN should be strictly followed surgical indications.