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目的:对比后腹腔镜节段性肾动脉阻断保留肾单位手术(SRPN)与后腹腔镜肾动脉阻断保留肾单位手术(LPN)的临床结果,探讨SRPN对术后患肾功能的保护及生存结果。方法:回顾性分析贵州医科大学附属医院2008年4月~2012年3月治疗的47例局限性T1a期肾肿瘤患者的临床资料,其中19例患者行SRPN(A组),28例行LPN(B组)。随访5年,监测患肾GFR变化情况,收集并统计患者生存情况,并进行统计学分析。结果:随访5年,无一例患者出现转移及复发,A组1例患者术后第27个月发现输尿管结石,B组1例患者术后第23个月不慎摔伤导致肾挫伤,1例患者术后第38个月发现肾结石,1例患者于术后第47个月就诊发现肾功能急剧下降。两组5年总生存率均为100%,无病生存率分别为94.7%、89.3%(P>0.05)。术后3个月、6个月、12个月、24个月、60个月,两组患肾功能下降绝对值分别为(6.87±1.78)ml/min vs.(12.64±1.64)ml/min、(8.45±1.75)ml/min vs.(13.93±2.08)ml/min、(9.92±1.88)ml/min vs.(15.02±2.41)ml/min、(11.31±2.00)ml/min vs.(16.31±2.58)ml/min、(12.76±2.45)ml/min vs.(17.93±3.33)ml/min,差异均具有统计学意义(P<0.05)。结论:两组手术方式总生存率和无病生存率相同,说明手术方式的选择不影响患者存活期;术后患肾功能均有不同程度下降,且A组下降程度小于B组,提示SRPN手术可减缓术后肾功能下降,对术后肾功能具有保护作用,值得临床应用及推广。
Objective: To compare the clinical results of retroperitoneal laparoscopic segmental renal artery occlusion retained nephron surgery (SRPN) and laparoscopic renal artery occlusion retained nephron (LPN), and to explore the protective effect of SRPN on postoperative renal dysfunction and Survival results. Methods: The clinical data of 47 patients with T1a stage renal cell carcinoma treated in the Affiliated Hospital of Guizhou Medical University from April 2008 to March 2012 were retrospectively analyzed. Among them, 19 patients underwent SRPN (group A) and 28 patients underwent LPN Group B). Followed up for 5 years, monitored the changes of renal GFR, collected and calculated the survival of patients, and statistical analysis. Results: All cases were followed up for 5 years. None of the patients had metastasis and recurrence. One patient in group A had ureteral calculi found in the 27th month after operation. One patient in group B accidentally fell off after 23 months, Kidney stones were found in the 38th month postoperatively, and one patient showed a sharp drop in renal function at the 47th postoperative month. The 5-year overall survival rate was 100% in both groups, with a disease-free survival rate of 94.7% and 89.3%, respectively (P> 0.05). The absolute values of renal function decline in the two groups were (6.87 ± 1.78) ml / min vs. (12.64 ± 1.64) ml / min respectively at 3 months, 6 months, 12 months, 24 months and 60 months after operation , (8.45 ± 1.75) ml / min vs. (13.93 ± 2.08) ml / min, (9.92 ± 1.88) ml / min vs. (15.02 ± 2.41) ml / min, (11.31 ± 2.00) ml / min vs. 16.31 ± 2.58) ml / min, (12.76 ± 2.45) ml / min vs. (17.93 ± 3.33) ml / min, respectively, with statistical significance (P <0.05). Conclusion: The overall survival rate and disease-free survival rate of the two groups were the same, indicating that the choice of surgical procedure did not affect the survival of patients. The postoperative renal function declined to some extent, and the decrease in group A was less than that in group B, suggesting that SRPN surgery Can reduce postoperative renal function decline, postoperative renal function has a protective effect, it is worth the clinical application and promotion.