【摘 要】
：
背景与目的:肾部分切除术已经成为T1a期肾癌的标准手术方式,而对于T1b期肾癌只要技术可行,肾部分切除术较肾癌根治术病人也获利更多.随着各国指南不再强调肿瘤切缘的宽度,紧贴肾肿瘤假包膜外侧的肾肿瘤剜切术,除了可以依靠清晰可见的肿瘤轮廓作为解剖标记外还可以保留更多的正常肾组织而越来越受到各国医生的青睐.本研究比较常规的腹腔镜肾部分切除术和腹腔镜肾肿瘤剜切术治疗T1期肾癌在围手术期手术效果、肿瘤根治和
【机 构】
：
中山大学孙逸仙纪念医院泌尿外科 南方医科大学南方医院泌尿外科
【出 处】
：
第十三届亚洲泌尿外科学会年会(UAA2015)、第二十二届全国泌尿外科学术会议(CUA2015)、第十六届全军及武警泌尿
论文部分内容阅读
背景与目的:肾部分切除术已经成为T1a期肾癌的标准手术方式,而对于T1b期肾癌只要技术可行,肾部分切除术较肾癌根治术病人也获利更多.随着各国指南不再强调肿瘤切缘的宽度,紧贴肾肿瘤假包膜外侧的肾肿瘤剜切术,除了可以依靠清晰可见的肿瘤轮廓作为解剖标记外还可以保留更多的正常肾组织而越来越受到各国医生的青睐.本研究比较常规的腹腔镜肾部分切除术和腹腔镜肾肿瘤剜切术治疗T1期肾癌在围手术期手术效果、肿瘤根治和肾功能保护方面的疗效.方法:回顾性分析三个医院270例行腹腔镜肾部分切除术的T1期肾癌患者资料,依据年龄、性别、BMI、ASA评分、eGFR、肿瘤大小、RENAL评分、Charlson评分、是否孤立肾采用倾向性评分匹配分析.比较两种术式在围手术期手术效果、肿瘤根治和肾功能保护方面的疗效.结果:98对腹腔镜肾部分切除术和腹腔镜肾肿瘤剜切术患者配对成功.各组均有1例患者更改为腹腔镜肾癌根治术,无更改开放手术病例.肾肿瘤剜切组患者较常规肾部分切除组在热缺血时间(20.8:23.8分钟,P=0.003)和总手术时间(130.8:152.1分钟,P=0.005)上更少,出血量也更少(50:90mL,P=0.045).两组的并发症发生率(11.9％:11.2％,P=0.3)、阳性切缘率(1.8％:1.0％,P=0.62)、局部复发率(1.0％:1.0％,P=1.0)无明显差异.随访3年,两组的eGFR无明显差异(89.2±30.7:92.4±29.8,P=0.6).结论:腹腔镜肾肿瘤剜切术是可行的手术方式,不仅可以保留更多的正常肾组织,减少术中热缺血时间、总手术时间和出血量,而且并不降低肿瘤的根治效果,值得临床推广.
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