不阻断肾动脉保留肾单位手术治疗局限性肾癌的临床分析

发布时间：2018-03-17 05:04

本文选题：早期肾癌　切入点：保留肾单位手术　出处：《郑州大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的通过对比研究不阻断肾动脉保留肾单位手术与传统阻断肾动脉保留肾单位手术治疗局限性肾癌的临床指标，评估不阻断肾动脉保留肾单位手术的疗效及安全性。方法回顾性分析郑州大学附属肿瘤医院在2012年4月-2013年12月期间的84例行保留肾单位手术治疗的小肾癌患者，其中41例患者行不阻断肾动脉保留肾单位手术（观察组），43例行传统阻断肾动脉保留肾单位手术（对照组）。对两组患者肿瘤大小、手术时间、术中出血量、切缘阴性率；术后第1天引流量、术后住院时间、相关并发症；术前和术后1周、6月肌酐水平变化；术前、术后3月和术后6月患侧肾GFR变化等指标进行回顾性分析。通过病案查询、术后随访等方式获得相关临床资料，进行对比研究，评估不阻断肾动脉保留肾单位手术治疗局限性肾癌的疗效及安全性。结果 84例患者均成功行保留肾单位手术。不阻断肾动脉组与阻断肾动脉组的平均肿瘤大小分别为2.8±0.7cm和3.0±0.6cm，无明显统计学差异（P＞0.05）；手术时间分别为141.5±29.6min和132.7±30.1min，无明显统计学差异（P＞0.05）；术中出血量分别为289.5±86.5ml和97.5±33.5ml，存在显著统计学差异（P＜0.05）；术后第1天引流量分别为197.75±13.6ml和201.3±12.2ml，无明显统计学差异（P＞0.05）；术后住院时间分别为9.0±0.8d和9.1±0.9d，无明显统计学差异（P＞0.05）；阻断肾动脉组平均阻断时间为21.23±3.89min，术前肌酐水平分别为65.40±11.90μmol/L和64.24±8.64μmol/L，无明显统计学差异（P＞0.05）；术后1周肌酐水平较术前差值分别为88.40±8.47μmol/L和105.43±9.33μmol/L，存在显著统计学差异（P＜0.05）；术后6月肌酐水平较术前差值分别为67.35±9.69μmol/L和65.48±7.31μmol/L，无明显统计学差异（P＞0.05）；术前患肾GFR分别为52.61±6.22ml/min和51.29±3.99ml/min，无明显统计学差异（P＞0.05）；术后3月患肾GFR分别为46.59±6.19ml/min和35.45±3.77ml/min，存在明显统计学差异（P＜0.05），术后6月患肾GFR分别为48.42±6.07ml/min和37.72±3.67ml/min，存在明显统计学差异（P＜0.05）。术后病理示两组患者切缘均为阴性。两组患者在随访期间均未发生肿瘤复发及转移。阻断肾动脉手术组1例患者发生术后切口感染，对症处理后痊愈，，两组均无死亡病例。结论不阻断肾动脉保留肾单位手术是一种可推广的手术方式，但需要选择合适的病材。
[Abstract]:Purpose. To evaluate the efficacy and safety of renal artery sparing surgery without blocking renal artery in the treatment of local renal cell carcinoma, the clinical indexes of renal unit sparing surgery without renal artery occlusion and traditional renal artery sparing unit surgery were compared. Method. A retrospective analysis was made on 84 patients with small renal cell carcinoma treated by nephron-sparing surgery from April 2012 to December 2013 in the affiliated Cancer Hospital of Zhengzhou University. Among them, 41 cases underwent renal unit sparing operation without renal artery occlusion (observation group 43 cases received traditional renal artery preservation surgery (control group). For the two groups, tumor size, operation time, intraoperative bleeding volume, margin negative rate; On the first day after operation, drainage, hospital stay, related complications, creatinine level before and after 1 week, June, preoperative, postoperative March and June after operation were analyzed retrospectively. To evaluate the efficacy and safety of renal unit sparing surgery without blocking renal artery in the treatment of local renal cell carcinoma. Results. The mean tumor size was 2.8 卤0.7cm and 3.0 卤0.6cm in the unblocked renal artery group and 3.0 卤0.6 cm in the renal artery occlusion group, respectively (P > 0.05), and the operative time was 141.5 卤29.6min and 132.7 卤30.1min, respectively. The volume of intraoperative bleeding was 289.5 卤86.5 ml and 97.5 卤33.5 ml, respectively (P < 0.05), the drainage volume was 197.75 卤13.6ml and 201.3 卤12.2ml on the first day after operation, there was no significant difference (P > 0.05), and the hospitalization time was 9.0 卤0.8d and 9.1 卤0.9d, respectively (P > 0.05). The mean occlusion time was 21.23 卤3.89 minutes, the preoperative creatinine levels were 65.40 卤11.90 渭 mol/L and 64.24 卤8.64 渭 mol / L, respectively (P > 0.05), and the creatinine levels were 88.40 卤8.47 渭 mol/L and 105.43 卤9.33 渭 mol / L respectively at 1 week after operation (P < 0.05). The anterior difference was 67.35 卤9.69 渭 mol/L and 65.48 卤7.31 渭 mol / L, respectively (P > 0.05), and the preoperative GFR was 52.61 卤6.22 ml / min and 51.29 卤3.99 ml / min, respectively (P > 0.05). On March, the renal GFR was 46.59 卤6.19 ml / min and 35.45 卤3.77 ml / min, respectively (P < 0.05). For 48.42 卤6.07ml / min and 37.72 卤3.67ml / min, there was significant difference (P < 0.05). Postoperative pathology showed that the margin of resection was negative in both groups. No tumor recurrence or metastasis occurred in the two groups during the follow-up period. One patient in the renal artery occlusion group developed postoperative incision infection. There were no death cases in both groups. Conclusion. Renal artery-sparing surgery without blocking renal artery is a popularized procedure, but it is necessary to select suitable materials.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.11

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