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目的:探讨中国人民解放军总医院单一术者(董隽)2007~2015年肾肿瘤患者临床特点和手术方式变化。方法:回顾性分析2007~2015年诊治945例肾肿瘤患者资料,包括:年龄、性别、肿瘤大小、TNM分期、手术方式、病理类型、保留肾单位手术热缺血时间等。将临床资料分为3个阶段进行比较分析:第1阶段(2007~2009年)以开放手术为主,腹腔镜手术逐步得以应用;第2阶段(2010~2014年)以腹腔镜手术广泛应用为主;第3阶段(2015年)机器人辅助腹腔镜保留肾单位手术广泛开展。结果:2007~2015年,肾肿瘤手术例数逐年增多。男女比例、平均初诊年龄无明显变化,肿瘤最大直径由4.11cm降至3.91cm。T1a、T1b期患者增多,热缺血时间减少。肾肿瘤开放手术比例由2007~2009年的60.36%降至2015年的3.92%;肾肿瘤微创手术比例由2007~2009年的39.64%增至2015年的96.08%。保留肾单位手术比例上升,肾根治性手术比例下降。结论:2007~2015年肾肿瘤临床特点及手术方式已发生明显变化,早期肾肿瘤就诊率增多,微创手术比例上升,开放手术比例下降。机器人辅助腹腔镜保留肾单位手术比例近年来逐渐增大。
Objective: To investigate the clinical features and surgical modalities of patients with renal neoplasm from 2007 to 2015 in the PLA General Hospital (Dong Jun). Methods: The data of 945 renal cancer patients diagnosed and treated from 2007 to 2015 were retrospectively analyzed. The data included age, sex, tumor size, TNM stage, operation mode, pathological type, and the time of warm ischemia during nephron preservation. The clinical data were divided into three stages for comparative analysis: the first stage (2007 ~ 2009) mainly open surgery, laparoscopic surgery gradually be applied; the second phase (2010 ~ 2014) laparoscopic surgery widely used as Lord; Stage 3 (2015) Robotic assisted laparoscopic nephron-sparing surgery is widely performed. Results: From 2007 to 2015, the number of cases of kidney tumors increased year by year. The ratio of male to female, average age at diagnosis, had no significant change, the maximum diameter of tumor decreased from 4.11cm to 3.91cm. T1a, T1b patients increased, warm ischemic time decreased. The proportion of open renal neoplasms decreased from 60.36% in 2007-2009 to 3.92% in 2015; the proportion of minimally invasive nephrotic tumors increased from 39.64% in 2007-2009 to 96.08% in 2015. The proportion of nephrons retained surgery increased, the proportion of radical nephrectomy decreased. CONCLUSION: The clinical features and operation methods of renal tumors have changed significantly from 2007 to 2015. The incidence of early renal tumors increased, the proportion of minimally invasive surgery increased, and the proportion of open surgery decreased. Robot-assisted laparoscopic nephron surgery to keep the proportion of surgery in recent years gradually increased.