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目的:总结腹腔镜肾肿瘤剜除术治疗T_(1a)N_0M_0期肾癌的临床经验。方法:回顾性分析2006年10月~2012年10月接受腹腔镜保留肾单位手术(LNSS)的1 79例T_(1a)N_0M_0期肾癌患者临床资料,按手术方式分为A、B两组,A组为接受腹腔镜肾肿瘤剜除术(LTE)患者,共94例,B组为接受标准腹腔镜肾部分切除术(LPN)患行,共85例,对两组患者基本资料、围手术期情况、组织病理学结果及随访结果进行统计学分析。结果:A组、B组的手术时间、肾动脉阻断率及阻断时间之间比较差异无统计学意义(P>0.05)。A组术中失血量及输血率、术后并发症发生率及术后住院时间均较B组下降,差异有统计学意义(P<0.05)。术后病理证实A、B组切缘阳性分别有1例(1.1%)、3例(3.5%),癌组织累及但未穿透假包膜分别有22例(23.4%)、27例(31.8%),均差别无统计学意义(P>0.05)。平均随访时间(33.5±20.9)个月,两组患者术后12个月eGFR水平较术前差异无统计学意义。A组1例(1.1%)出现同侧肾脏异位复发,1例(1.1%)出现肺转移;B组原位复发、同侧肾脏异位复发、肺转移各1例;两组间复发率、转移率差异无统计学意义(P>0.05)。结论:LTE可获得与LPN相同的肿瘤学效果,有利于保留更多的正常肾组织,且并发症发生率较低,是治疗T_(1a)N_0M_0期肾癌有效的手段。
Objective: To summarize the clinical experience of laparoscopic nephrectomy for the treatment of T_ (1a) N_0M_0 stage renal cell carcinoma. Methods: The clinical data of 1 79 cases of T 1 (N 0M 0) stage renal cell carcinoma undergoing laparoscopic nephron sparing surgery (LNSS) from October 2006 to October 2012 were retrospectively analyzed. The patients were divided into two groups , Group A received 94 patients with laparoscopic nephroureterectomy (LTE), group B received standard laparoscopic partial nephrectomy (LPN), a total of 85 cases, the basic data of two groups of patients, Wai The operative conditions, histopathological findings and follow-up results were statistically analyzed. Results: There was no significant difference in the operative time, the blocking rate of renal artery and the blocking time between group A and group B (P> 0.05). The intraoperative blood loss and transfusion rate, the incidence of postoperative complications and postoperative hospital stay in group A were significantly lower than those in group B (P <0.05). Postoperative pathology confirmed that there were 1 (1.1%) and 3 (3.5%) positive margins in group A and B, respectively. There were 22 cases (23.4%) and 27 cases (31.8% %), No difference was statistically significant (P> 0.05). The mean follow-up time was 33.5 ± 20.9 months. There was no significant difference in eGFR level between the two groups at 12 months after operation. One case (1.1%) in group A showed ectopic recurrence of ipsilateral kidney and one case (1.1%) had lung metastasis. In situ recurrence in group B, ectopic recurrence and lung metastasis in ipsilateral kidney were observed in one case. The recurrence rate , There was no significant difference in metastasis rate (P> 0.05). Conclusion: LTE can achieve the same oncology effect as LPN, which is beneficial to retain more normal kidney tissue with lower complication rate. It is an effective method to treat T_ (1a) N_0M_0 stage renal cell carcinoma.