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目的不同分期的肾细胞癌具体手术方案的选择还存在着争议,本研究旨在比较经后腹腔镜和开放性肾癌根治术2种术式对于T2期肾细胞癌的治疗效果和安全性。方法分析2008年2月—2009年2月在台州市立医院接受住院手术治疗的T2期肾细胞癌患者的临床资料,根据手术方案分为观察组(后腹腔镜下肾癌根治术组)和对照组(开放性肾癌根治术组)2组。观察比较2组患者的一般资料、手术时间、手术中出血量、术后并发症发生率、术后炎性指标变化、住院时间、住院费用等。血液炎性指标通过直接抽取外周静脉血和ELISA法测得。数据采用SPSS 19.0软件进行统计分析,采用t检验和χ2检验。结果本研究共入组患者80例,其中观察组38例,对照组42例。2组患者的术后并发症(χ2=09.258,P=0.61)和肿瘤直径(t=1.214,P=0.18)差异并无统计学意义,观察组的手术时间明显超过对照组(t=4.097,P<0.01),而术中出血量显著低于对照组(t=2.822,P<0.01);2组患者术后第1天炎症指标差异均无统计学意义(P均>0.05),而术后第7天时观察组患者的CRP(t=3.274,P<0.01)和IL-6(t=2.971,P<0.01)水平显著低于对照组;2组患者的住院总费用差异并无统计学意义(P>0.05),而观察组的住院时间显著少于对照组(t=3.731,P<0.01)。结论相对于开放性手术,经后腹腔镜下肾癌根治术手术时间偏长,治疗效果和5年生存率相当,但术中出血少、术后炎性指标恢复快、住院时间短。
The purpose of different stages of renal cell carcinoma specific surgical options is still controversial, the purpose of this study is to compare the two laparoscopic and open radical nephrectomy for T2 renal cell carcinoma of the treatment effect and safety. Methods The clinical data of patients with stage T2 renal cell carcinoma undergoing inpatient surgery in Taizhou Municipal Hospital from February 2008 to February 2009 were analyzed. The patients were divided into observation group (retroperitoneal laparoscopic radical nephrectomy group) and control group Group (open renal cell carcinoma group) 2 groups. The general data, operation time, blood loss during operation, incidence of postoperative complications, changes of postoperative inflammatory indexes, hospitalization time and hospitalization expenses were observed and compared between the two groups. Blood inflammatory parameters were measured by direct extraction of peripheral venous blood and ELISA. Data were analyzed by SPSS 19.0 software using t-test and χ2 test. Results A total of 80 patients were enrolled in this study, including 38 cases in the observation group and 42 cases in the control group. There were no significant differences in postoperative complications (χ2 = 09.258, P = 0.61) and tumor diameter (t = 1.214, P = 0.18) between the two groups. The operation time in the observation group was significantly higher than that in the control group P <0.01), while the amount of bleeding during operation was significantly lower than that of the control group (t = 2.822, P <0.01). There was no significant difference in inflammation index between the two groups on the first postoperative day (P> 0.05) The levels of CRP (t = 3.274, P <0.01) and IL-6 (t = 2.971, P <0.01) in the observation group were significantly lower than those in the control group on the 7th day after surgery. There was no statistical difference in the total cost of hospitalization between the two groups (P> 0.05), while the observation group’s hospitalization time was significantly less than the control group (t = 3.731, P <0.01). Conclusions Compared with open surgery, laparoscopic radical nephrectomy has a longer operative time and a 5-year survival rate, but less intraoperative bleeding, faster recovery of postoperative inflammatory markers and shorter hospital stay.