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目的探讨后腹腔镜下肾癌根治术(LRN)和后腹腔镜下保留肾单位手术(LNSS)治疗T1期肾癌的临床疗效。方法回顾性分析79例T1期肾癌患者的临床资料,其中LRN组42例,LNSS组37例。比较两组患者的手术时间、术后短期并发症(包括急性肾衰竭、漏尿、严重感染)、手术前后肾功能及术后3年无瘤生存率等方面的差异。结果LRN组与LNSS组手术时间分别为(140±19)min与(148±24)min、术中出血量分别为(160±70)ml与(180±80)ml、术后3年无瘤生存率分别为91.3%与100.0%,差异均无统计学意义(P>0.05);术后短期并发症,LRN组中1例出现少尿,LNSS组中术后继发性出血、漏尿者各2例,出现严重感染、急性肾衰竭各1例,差异有统计学意义(P<0.05);远期肾功能改变,术后3年血肌酐LRN组(90.9±13.5)μmol/L、LNSS组(81.4±14.3)μmol/L,差异有统计学意义(P<0.05)。结论对T1期肾癌的手术治疗,LRN和LNSS术后无瘤生存率相似,但LRN对患者术后肾功能的影响远较LNSS明显。因此,在技术和条件许可的情况下,可优先选择LNSS治疗。
Objective To investigate the clinical effects of retroperitoneal laparoscopic radical nephrectomy (LRN) and laparoscopic nephron surgery (LNSS) on T1 stage renal cell carcinoma. Methods The clinical data of 79 patients with T1 stage renal cell carcinoma were analyzed retrospectively, including 42 cases of LRN and 37 cases of LNSS. The difference of operation time, postoperative short-term complications (including acute renal failure, leakage of urine and serious infection), renal function before and after surgery and the 3-year disease-free survival rate were compared between the two groups. Results The operative time of LRN group and LNSS group were (140 ± 19) min and (148 ± 24) min respectively, and the intraoperative blood loss were (160 ± 70) ml and (180 ± 80) ml, respectively The survival rates were 91.3% and 100.0%, respectively, with no significant difference (P> 0.05). Short-term complication after operation was found in 1 case in LRN group, oliguria occurred in postoperative patients in LNSS group, (P <0.05); long-term renal function changes, postoperative serum creatinine LRN group (90.9 ± 13.5) μmol / L, LNSS Group (81.4 ± 14.3) μmol / L, the difference was statistically significant (P <0.05). Conclusions The surgical treatment of T1 stage renal carcinoma has similar tumor-free survival rate after LRN and LNSS. However, the effect of LRN on postoperative renal function is much more obvious than that of LNSS. Therefore, LNSS treatment may be given preference given the technical and conditions permitting.