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目的:探讨后腹腔镜保留肾单位手术(LNSS)对早期肾癌患者术后术肾肾功能的影响。方法:收集并随访新疆维吾尔自治区人民医院泌尿外科2009年1月~2012年6月接受经后腹膜行腹腔镜保留肾单位术治疗,且术后病检结果为肾癌患者的临床资料,分别于术前、术后24小时、2周、6月、1年、1.5年、2年测定双肾GFR、血清肌酐、血清胱抑素指标值,随访时间大于2年的有28例患者,比较并分析各指标值的变化情况,分析LNSS术对肾功能的影响。结果:28例患者术肾术前GFR及占总GFR的比例分别为42.02±7.31 ml/min和43.30±3.6%,术后2周分别为31.42±5.23 ml/min和34.83±5.8%,术后6月分别为33.23±5.46ml/min和36.85±5.3%,术后1年分别为37.21±6.59 ml/min和39.74±6.2%,术后1.5年分别为40.44±5.82 ml/min和42.26±6.2%,术后2年分别为40.64±5.74 ml/min和42.26±5.8%。术后24小时,血清肌酐水平升高,术后6个月以后与术前比较无明显差别。术后2周,血清胱抑素水平升高,术后6个月恢复到术前水平。结论:LNSS术式对早期肾癌是安全有效的。
Objective: To investigate the effect of retroperitoneal laparoscopic nephron surgery (LNSS) on renal function in patients with early stage renal cell carcinoma after operation. Methods: We collected and followed-up the urology department of People’s Hospital of Xinjiang Uygur Autonomous Region from January 2009 to June 2012. The clinical data of patients who underwent laparoscopic nephron preservation by retroperitoneal laparoscopy and postoperative pathological examination were renal cell carcinoma patients. Preoperative, postoperative 24 hours, 2 weeks, 6 months, 1 year, 1.5 years, 2 years determination of renal GFR, serum creatinine, serum cystatin index values, follow-up time of more than 2 years, 28 patients were compared Analysis of changes in the value of indicators, analysis of the impact of LNSS on renal function. Results: The preoperative GFR and total GFR in 28 patients were 42.02 ± 7.31 ml / min and 43.30 ± 3.6%, respectively. The postoperative 2 weeks were 31.42 ± 5.23 ml / min and 34.83 ± 5.8% 33.23 ± 5.46ml / min and 36.85 ± 5.3% respectively in June and 37.21 ± 6.59ml / min and 39.74 ± 6.2% respectively at 1 year after operation and 40.44 ± 5.82ml / 42.26 ± 6.2 %, 40.64 ± 5.74 ml / min and 42.26 ± 5.8% respectively after 2 years. Serum creatinine increased 24 hours after surgery, and there was no significant difference after 6 months compared with preoperative. Serum levels of cystatin increased 2 weeks after surgery and returned to preoperative levels 6 months after surgery. Conclusion: LNSS is safe and effective for early stage renal cell carcinoma.