代谢综合征对肾细胞癌围手术期的影响

发布时间：2018-10-26 08:37

【摘要】：目的:回顾性研究代谢综合征(metabolic syndrome,MS)对肾细胞癌(renal cell carcinoma,RCC)围手术期的术前准备、手术过程中及术后患者恢复等方面的影响,以指导临床对合并代谢综合征患者预后进行预测并提前干预。方法:收集自2011年1月到2017年3月期间就诊于皖南医学院附属弋矶山医院泌尿外科的所有TNM分期为T1、T2期的肾细胞癌患者,挑选自发现肾占位性病变到行根治性肾癌切除术,再到术后病明确肾癌诊断全程均在我院共247例,分析所有肾癌患者的临床资料。按患者术前是否合并代谢综合征分为MS组(84例)、非MS(163例),对比两组患者的年龄、术前准备时间、性别差异、临床分期、术后病理类型及分化程度等相关指标。并针对不同手术方式分为腹腔镜组(共104,其中MS患者38例,非MS患者66例),开放组(共143例,其中MS患者46例,非MS患者97例),比较不同术式下MS与非MS患者的手术时间、术中出血、术后肠道功能恢复时间、术后下床活动时间、术后发热、腹膜后引流管及导尿管拔出时间、术后住院时间等指标。用SPPS19.0统计软件比较不同分组间的数据,T检验分析计量资料,2X检验分析计数资料,以P0.05为差异有统计学意义。结果:1、MS组肾癌患者的男女比例为25/29、平均年龄为55.93±10.34岁较非MS组肾癌患者男女比例132/31、平均年龄55.93±10.34岁无统计学差异(P0.05);术前准备时间5.47±1.52d与3.54±1.27d差异经T检验具有统计学意义;但是通过卡方检验发现MS对临床分期无明显影响,差异无统计学意义。2、腹腔镜手术方式下肾癌患者,MS患者的手术时间、术中出血、术后肠道功能恢复时间、术后下床活动时间、术后发热、腹膜后引流管拔出时间、术后住院时间均较非MS患者不同,且差异具有统计学意义(P0.05),导尿管拔出时间无统计学差异;开放手术下肾癌患者,MS患者的手术时间、术中出血、术后肠道功能恢复时间、术后下床活动时间、术后发热、腹膜后引流管拔出时间、术后住院时间均较非MS患者不同,且差异具有统计学意义(P0.05),导尿管拔出时间无统计学差异。3、透明细胞癌的患者同时伴有代谢综合征的比例最高(67/93),乳头细胞癌(11/54)、嫌色细胞癌(5/12),同时各种类型细胞癌占总体比例无明显变化。透明细胞癌的Furhman分级的Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级的患者MS发生率分别为46%、53%、43%、28%。结论:MS的发生具有性别差异,同时MS对RCC围手术期及临床恢复具有明显的负面影响,MS患者易发生肾透明细胞癌,然而高Furhman分级的患者并发MS风险降低,因此对于高分级的肿瘤可能与代谢性因素关系不定。
[Abstract]:Objective: to study retrospectively the effects of metabolic syndrome (metabolic syndrome,MS) on the preoperative preparation and recovery of patients with renal cell carcinoma (renal cell carcinoma,RCC) during the perioperative period. To guide the clinical prognosis of patients with metabolic syndrome and early intervention. Methods: from January 2011 to March 2017, all patients with renal cell carcinoma (RCC) with TNM staging T _ 1 and T _ 2 were selected from January 2011 to March 2017 to receive radical nephrectomy (RCC) in the Department of Urology, affiliated to Yiji Mountain Hospital of Southern Anhui Medical College. 247 cases of renal cell carcinoma were diagnosed in our hospital. The clinical data of all patients with renal cell carcinoma were analyzed. The patients were divided into MS group (84 cases) and non MS group (163 cases) according to whether the patients were complicated with metabolic syndrome before operation. The age, preparation time, sex difference, clinical stage, pathological type and differentiation degree of the two groups were compared. The patients were divided into laparoscopic group (104 cases, 38 cases of MS, 66 cases of non-MS) and open group (143 cases, including 46 cases of MS and 97 cases of non-MS). The operative time, intraoperative bleeding, postoperative intestinal function recovery time, postoperative bed movement time, postoperative fever, retroperitoneal drainage tube and catheter extubation time and postoperative hospitalization time were compared between patients with MS and non-MS under different operation methods. SPPS19.0 statistical software was used to compare the data between different groups, T-test analysis of measurement data, 2X test analysis of counting data, with P0.05 as the difference was statistically significant. Results: (1) the ratio of male to female in MS group was 25 / 29, the average age was 55.93 卤10.34 years old, and there was no significant difference between male and female ratio of 132 / 31 in MS group compared with that in non-MS group (P0.05). The difference of preoperative preparation time between 5.47 卤1.52d and 3.54 卤1.27d was statistically significant by T test. However, chi-square test showed that MS had no significant effect on clinical staging. 2. Laparoscopic renal cell carcinoma patients, MS patients, operative time, intraoperative bleeding, postoperative intestinal function recovery time, The time of getting out of bed, postoperative fever, extubation time of retroperitoneal drainage tube, postoperative hospitalization time were different from those of non-MS patients, and the difference was statistically significant (P0.05), and there was no significant difference in the time of catheter pullout. The operative time, intraoperative bleeding, recovery time of intestinal function, time of getting out of bed, postoperative fever, extubation of retroperitoneal drainage tube, postoperative hospitalization time of MS patients were different compared with those of non-MS patients. And the difference was statistically significant (P0.05). There was no significant difference in the time of catheter pullout. 3. The percentage of patients with clear cell carcinoma with metabolic syndrome was the highest (67 / 93), papillary cell carcinoma (11 / 54). Chromophobe cell carcinoma (5 / 12), at the same time, all types of cell carcinoma accounted for no significant change in the overall percentage. The incidence of MS in patients with Furhman grade 鈪，

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