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目的:比较腹腔镜和开放肾部分切除术两种经典术式治疗T1b期肾癌的临床效果。方法:回顾性分析2009年1月~2014年2月本中心215例接受肾部分切除术治疗的T1b期肾肿瘤患者的临床资料,其中男127例,女88例;平均年龄56.4(21~77)岁;左侧102例,右侧113例;肿瘤平均直径5.7(4.5~6.5)cm。155例患者行腹腔镜肾部分切除术(laparoscopic partial nephrectomy,LPN),60例患者行开放肾部分切除术(open partial nephrectomy,OPN)。比较两组手术时间、热缺血时间、术中出血量、并发症、术后住院时间及生存预后情况等指标。结果:LPN组平均手术时间为(114.2±21.7)min,OPN组平均手术时间为(117.3±29.2)min,两组差异无统计学意义(P>0.5)。两组平均热缺血时间分别为(23.6±9.3)min和(20.1±5.8)min,差异无统计学意义(P>0.5)。两组术中平均出血量分别为(152±123.8)ml和(238±164.7)ml,差异有统计学意义(P=0.041)。两组术后并发症分别为5.2%(8/155)和5.0%(3/60)。其中LPN组6例出血,2例尿瘘;OPN组2例出血,1例尿瘘;两组比较差异无统计学意义(P>0.05)。LPN组和OPN组术后住院时间分别(6.0±0.9)d和(8.6±1.1)d,两组比较差异有统计学意义(P=0.039);两组术后平均随访52.2(28~89)个月,LPN组4例局部复发,OPN组3例局部复发;两组中各有2例肺转移。随访期间,两组无肿瘤相关死亡病例。结论:腹腔镜下肾部分切除术治疗选择性的T1b期肾肿瘤具有出血量少、住院时间短等优点,近期临床疗效和并发症发生率与开放手术组相近,是一种可行的治疗T1b期肾肿瘤的技术手段,但远期疗效需进一步随访观察。
OBJECTIVE: To compare the clinical effects of two classic procedures of laparoscopic and open partial nephrectomy for T1b stage renal cell carcinoma. Methods: The clinical data of 215 patients with T1b renal neoplasm who underwent partial nephrectomy in our center from January 2009 to February 2014 were retrospectively analyzed. There were 127 males and 88 females with a mean age of 56.4 (21-77) ) Years old; left 102 cases, right 113 cases; tumor average diameter 5.7 (4.5 ~ 6.5) cm. Laparoscopic partial nephrectomy (LPN) was performed in 155 patients and open partial nephrectomy (OPN) in 60 patients. The operation time, warm ischemia time, intraoperative blood loss, complications, postoperative hospital stay and survival and prognosis were compared between the two groups. Results: The mean operation time was (114.2 ± 21.7) min in LPN group and 117.3 ± 29.2 min in OPN group. There was no significant difference between the two groups (P> 0.5). Mean warm ischemia time in the two groups was (23.6 ± 9.3) min and (20.1 ± 5.8) min, respectively, with no significant difference (P> 0.5). The average intraoperative blood loss was (152 ± 123.8) ml and (238 ± 164.7) ml, respectively, with statistical significance (P = 0.041). The postoperative complications in both groups were 5.2% (8/155) and 5.0% (3/60) respectively. There were 6 cases of bleeding in LPN group, 2 cases of urinary fistula, 2 cases of OPN group and 1 case of urinary fistula. There was no significant difference between the two groups (P> 0.05). The postoperative hospital stay in LPN group and OPN group were (6.0 ± 0.9) d and (8.6 ± 1.1) days, respectively, with significant difference between the two groups (P = 0.039); mean follow-up was 52.2 (28-89) In 4 months, 4 cases were locally recurred in the LPN group and 3 cases were locally recurrent in the OPN group. There were 2 cases of lung metastases in each group. During follow-up, there were no cancer-related deaths in both groups. Conclusions: Laparoscopic partial nephrectomy for the treatment of T1b renal cell carcinoma of choice has the advantages of less bleeding, shorter hospital stay and so on. The recent clinical efficacy and complication rate are similar to open surgery group, which is a feasible treatment for T1b stage Kidney neoplasms technical means, but the long-term efficacy needs further follow-up observation.