保留肾单位手术治疗T1b期肾癌可行性分析

发布时间：2018-03-29 21:42

本文选题：肾细胞癌　切入点：肾部分切除术　出处：《郑州大学》2014年硕士论文

【摘要】：目的评价保留肾单位手术治疗T1b期肾癌的安全性与可行性。方法回顾性对照研究2007年1月至2009年1月郑州大学第一附属医院泌尿外科131例T1b期肾癌的临床资料，其中行保留肾单位手术治疗者64例，行根治性肾切除术治疗者67例。统计分析两组患者年龄、性别、肿瘤位置分布、肿瘤最大直径、手术时间、术中出血量、术后引流量、术后引流管留置时间、术后胃肠功能恢复时间、术后住院天数、术后并发症、术后肾功能变化、术后肾小球滤过率变化、肿瘤复发情况、保留肾单位手术肾脏血流阻断时间及切缘阳性率、术后肿瘤控制率等指标的差异有无统计学意义，评价保留肾单位手术治疗T1b期肾癌的安全性与可行性。结果 1．保留肾单位手术组与根治性肾切除术组在输血率、胃肠恢复时间、术后住院时间、引流管留置时间差异无统计学意义(P＞0.05)；保留肾单位手术组与根治性肾切除术组手术时间、术中出血量、术后引流量、并发症发生率差异有统计学意义(P＜0.05)。 2．保留肾单位手术组患者术后5年血清肌酐水平（SCr）较术前均升高，但配对t检验，两者差异无统计学意(P0.05)；根治性肾切除术组患者术后5年血清肌酐水平（SCr）较术前均升高，配对t检验，差异有统计学意义(P0.05)。分别比较保留肾单位手术组患者术前、术后5年的总肾小球滤过率、患侧肾小球滤过率、健侧肾小球滤过率差异无统计学意义(P0.05)；分别比较根治性肾切除术组患者术前、术后5年的总肾小球滤过率、健侧肾小球滤过率差异有统计学意义(P＜0.05)。 3．在随访期间，，保留肾单位手术组64例T1b期肾癌患者中有2例复发，复发率3.12%；根治性肾切除术中有2例复发，复发率为2.98%，比较两组患者术后肿瘤复发率差异无统计学意义(P0.05)。结论 T1b肾癌行保留肾单位手术与根治性肾切除术具有相似的肿瘤控制率，但在保护肾功能方面明显优于根治性肾切除术。位于肾脏两极、远离肾门、位置表浅、肿瘤相对较小、外生性生长、未侵犯或少量侵犯集合系统的T1b期肾癌建议行保留肾单位手术。切缘阴性、保护肾功能且无并发症是保留肾单位手术的理想效果。
[Abstract]:Purpose. To evaluate the safety and feasibility of nephron-sparing surgery for T 1b stage renal carcinoma. Method. From January 2007 to January 2009, the clinical data of 131 cases of stage T1b renal cell carcinoma in Urology Department, first affiliated Hospital of Zhengzhou University, were retrospectively studied. Among them, 64 cases were treated with nephron-sparing surgery. 67 patients were treated with radical nephrectomy. Age, sex, tumor location, tumor diameter, operation time, intraoperative bleeding volume, postoperative drainage volume, postoperative drainage tube indwelling time were statistically analyzed. Postoperative gastrointestinal function recovery time, postoperative hospitalization days, postoperative complications, postoperative changes of renal function, changes of glomerular filtration rate, recurrence of tumor, renal blood flow occlusion time and positive rate of incision margin in nephron-sparing surgery were analyzed. To evaluate the safety and feasibility of renal unit sparing surgery in the treatment of stage T 1b renal carcinoma. Results. 1. There was no significant difference in blood transfusion rate, gastrointestinal recovery time, postoperative hospitalization time and drainage tube indwelling time between the nephrectomy group and the radical nephrectomy group (P > 0.05), but the operative time between the nephron sparing operation group and the radical nephrectomy group was not significant (P > 0.05). There were significant differences in intraoperative bleeding, postoperative drainage and complications (P < 0.05). 2. The serum creatinine level in the nephrectomy group was significantly higher than that in the preoperative group, but there was no significant difference between the two groups in the paired t test (P 0.05), and the serum creatinine level in the radical nephrectomy group was higher than that in the preoperative group. The total glomerular filtration rate and the glomerular filtration rate of the patients in the nephron sparing operation group were compared 5 years before and 5 years after operation respectively. There was no significant difference in the glomerular filtration rate between the two groups (P < 0.05), and the total glomerular filtration rate in the radical nephrectomy group was significantly higher than that in the control group (P < 0.05), and the total glomerular filtration rate in the control group was significantly higher than that in the control group (P < 0.05). 3. During the follow-up period, in the nephron-sparing surgery group, 2 cases recurred in 64 cases of stage T1b renal carcinoma, and 2 cases in radical nephrectomy, the recurrence rate was 2.98%. There was no significant difference in the recurrence rate of tumor between the two groups (P 0.05). Conclusion. The tumor control rate of T1b renal carcinoma undergoing nephron-sparing surgery is similar to that of radical nephrectomy, but it is superior to radical nephrectomy in protecting renal function. Stage T1b renal cell carcinoma with ectogenic growth, no invasion or little invasion of the aggregate system is recommended to undergo nephron sparing surgery. Negative margin, protection of renal function and no complications are the ideal results of nephron-sparing surgery.
【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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