后腹腔镜下肾部分切除术对肾癌患者肾功能和预后的影响
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摘要
目的:探讨后腹腔镜下肾部分切除术对肾癌患者肾功能以及近远期预后的影响。方法:回顾性分析2012年1月～2017年8月在我院接受手术治疗的肾癌患者92例,根据不同手术治疗方法分为观察组(n=48)和对照组(n=44)。对照组行传统开放手术治疗,观察组行后腹腔镜下肾部分切除术。对比两组患者术前、术后血清肌酐(Cr)、血尿素氮(BUN)、β2-微球蛋白(β2-MG)、C反应蛋白(CRP)、白细胞介素-6(IL-6)水平的变化,术后1年、3年、5年生存率及切口感染、肺部感染、腹部疼痛、肾周血肿等并发症的发生情况。结果:观组患者手术时间、术后胃肠功能恢复时间、住院时间均明显短于对照组(P<0.05),术中出血量、术后引流管引流量均显著低于对照组(P<0.05)。术后1个月、术后2个月,两组患者血清Cr、BUN、β2-MG表达水平均较治疗前上升,且观察组以上指标显著低于对照组(P<0.05)。术后,两组患者血清CRP、IL-6水平虽有升高,但观察组以上指标明显低于对照组(P<0.05)。两组患者术后3年、5年的生存率均较术前下降,但观察组均分别高于对照组(P<0.05)。术后,两组患者均有出现切口感染、肺部感染、腹部疼痛、肾周血肿等并发症,观察组总发生率(10.42%)明显低于对照组(29.54%,P<0.05)。结论:后腹腔镜下肾部分切除术治疗肾癌患者可缩短患者的住院时间,对肾功能影响小,明显提高患者术后3年、5年生存率,且安全性更高。
Objective: To investigate the effect of retroperitoneal laparoscopic partial nephrectomy on renal function and long-term prognosis in patients with renal cancer. Methods: A retrospective analysis was made on 92 patients with renal cancer who underwent surgery in our hospital from January 2012 to August 2017. According to different surgical methods, the patients were divided into observation group(n=48) and control group(n=44). The control group received traditional open surgery, while the observation group received retroperitoneal laparoscopic partial nephrectomy. The changes of serum creatinine(Cr), blood urea nitrogen(BUN), beta-2-microglobulin(beta-2-MG), C-reactive protein(CRP), interleukin-6(IL-6) levels before and after operation, the 1-year, 3-year and 5-year survival rates, incision infection, pulmonary infection, abdominal pain, perirenal hematoma and other complications were compared between the two groups. Results: The operation time, recovery time of gastrointestinal function and hospitalization time in the observation group were significantly shorter than those in the control group(P<0.05). The amount of bleeding during operation and the drainage volume after operation were significantly lower than those in the control group(P<0.05). One month after operation and two months after operation, the levels of serum Cr, BUN and beta 2-MG in the two groups were higher than those before treatment, and the above indexes in the observation group were significantly lower than those in the control group(P<0.05). After operation, the serum CRP and IL-6 levels in the two groups increased, but the above indexes in the observation group were significantly lower than those in the control group(P< 0.05).The 3-year and 5-year survival rates of the two groups were lower than those of the control group, but the survival rates of the observation group were higher than those of the control group(P<0.05). After operation, incision infection, pulmonary infection, abdominal pain,perirenal hematoma and other complications occurred in both groups. The total incidence of the observation group(10.42%) was significantly lower than that of the control group(29.54%, P<0.05). Conclusion: Retroperitoneal laparoscopic partial nephrectomy can shorten the hospitalization time of patients with renal cancer, has little effect on renal function, and significantly improves the 3-year and 5-year survival rate of patients with renal cancer, and has higher safety.
Objective: To investigate the effect of retroperitoneal laparoscopic partial nephrectomy on renal function and long-term prognosis in patients with renal cancer. Methods: A retrospective analysis was made on 92 patients with renal cancer who underwent surgery in our hospital from January 2012 to August 2017. According to different surgical methods, the patients were divided into observation group(n=48) and control group(n=44). The control group received traditional open surgery, while the observation group received retroperitoneal laparoscopic partial nephrectomy. The changes of serum creatinine(Cr), blood urea nitrogen(BUN), beta-2-microglobulin(beta-2-MG), C-reactive protein(CRP), interleukin-6(IL-6) levels before and after operation, the 1-year, 3-year and 5-year survival rates, incision infection, pulmonary infection, abdominal pain, perirenal hematoma and other complications were compared between the two groups. Results: The operation time, recovery time of gastrointestinal function and hospitalization time in the observation group were significantly shorter than those in the control group(P<0.05). The amount of bleeding during operation and the drainage volume after operation were significantly lower than those in the control group(P<0.05). One month after operation and two months after operation, the levels of serum Cr, BUN and beta 2-MG in the two groups were higher than those before treatment, and the above indexes in the observation group were significantly lower than those in the control group(P<0.05). After operation, the serum CRP and IL-6 levels in the two groups increased, but the above indexes in the observation group were significantly lower than those in the control group(P< 0.05).The 3-year and 5-year survival rates of the two groups were lower than those of the control group, but the survival rates of the observation group were higher than those of the control group(P<0.05). After operation, incision infection, pulmonary infection, abdominal pain,perirenal hematoma and other complications occurred in both groups. The total incidence of the observation group(10.42%) was significantly lower than that of the control group(29.54%, P<0.05). Conclusion: Retroperitoneal laparoscopic partial nephrectomy can shorten the hospitalization time of patients with renal cancer, has little effect on renal function, and significantly improves the 3-year and 5-year survival rate of patients with renal cancer, and has higher safety.
引文
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[13]Chen W,Chen Y H,Zhang J,et al.The short-term efficacy of laparoscopic and open nephrectomy for the treatment of T_(1b)stage renal carcinoma[J].Journal of clinical department of Urology,2017,10(5):339-343
[14]Han G,Gong H J,Wang Y D,et al.A comparative analysis of gastrointestinal function and long-term prognosis in laparoscopic and open colorectal cancer radical surgery[J].Laparoscopic Surgery Journal,2016,12(6):433-436
[15]Zhang X M,Zhang D X,Cui X G,et al.Study on the safety and effectiveness of retroperitoneal laparoscopic partial nephrectomy for endogenetic renal carcinoma[J].Zhejiang clinical medicine,2017,12(8):1188-1190
[16]Ren T,Liu Y,Zhao X,et al.Transperitoneal Approach versus Retroperitoneal Approach:A Meta-Analysis of Laparoscopic Partial Nephrectomy for Renal Cell Carcinoma[J].Plos One,2017,9(3):e91978-e91980
[17]Zhang D X,Li X G,Cui X G,et al.The application of retroperitoneal laparoscopic partial nephrectomy in patients with moderate risk of renal cancer PADUA[J].Chinese Journal of surgery,2016,50(10):905-908
[18]Kim J H,Yong H P,Yong J K,et al.Perioperative and long-term renal functional outcomes of robotic versus laparoscopic partial nephrectomy:a multicenter matched-pair comparison[J].World Journal of Urology,2017,33(10):1579-1584
[19]He T,Y J J,Jia Zh K,et al.Comparison of the effect of retroperitoneal laparoscopic enucleation of renal carcinoma and traditional partial nephrectomy of renal tumor[J].Henan medical study,2016,23(2):71-73
[20]Wu Q,Zhang H.Carbon dioxide pneumothorax following retroperitoneal laparoscopic partial nephrectomy:a case report and literature review[J].BMC Anesthesiol,2018,18(1):202
[21]George T,Williams EH,Franklin R,et al.Two-Team Surgical Approach to Improve Retroperitoneal Nerve Identification in the Treatment of Groin Pain[J].Ann Plast Surg,2019,82(1):82-84
[22]Khan MA,Kahaleh M,Khan Z,et al.Time for a Changing of Guard:From Minimally Invasive Surgery to Endoscopic Drainage for Management of Pancreatic Walled-off Necrosis[J].J Clin Gastroenterol,2019,53(2):81-88
[23]Acosta R V,Ladjevardi S,Brekkan E,et al.Periprocedural outcome after laparoscopic partial nephrectomy versus radiofrequency ablation for T1 renal tumors:a modified R.E.N.A.L nephrometry score adjusted comparison[J].Acta Radiologica,2018:284185118780891
[24]Garzon S,Raffaelli R,Montin U,et al.Primary hepatic pregnancy:report of a case treated with laparoscopic approach and review of the literature[J].Fertil Steril,2018,110(5):925-931
[25]Tay WK,Kesavan A.Goh YSBRight Living Donor Nephrectomies:Retroperitoneoscopic vs Laparoscopic Transperitoneal Approach[J].Transplant Proc,2018,50(8):2333-2337
[26]Zhang L,Gao M,Zhang,et al.Surgical management of retroperitoneal schwannoma complicated with severe hydronephrosis:A case report[J].Medicine(Baltimore),2018,97(39):e12528
[27]Chen Q,Shuai X,Chen L.Safety and feasibility of the combined medial and caudal approach in laparoscopic D3 lymphadenectomy plus complete mesocolic excision for right hemicolectomy in the treatment of right hemicolon cancer complicated with incomplete ileus[J].Zhonghua Wei Chang Wai Ke Za Zhi,2018,21(9):1039-1044
[28]Limbachia D,Gandhi P.Laparoscopic retrieval of a foreign body(broken surgical knife)from retroperitoneal space:An interesting case[J].Gynecol Minim Invasive Ther,2017,6(4):193-194
[29]Ielpo B,SimóV,Pastor E,et al.Combined transanal minimally invasive surgery(TAMIS)and retroperitoneal laparoscopy for resection of lymph node recurrence of ovarian cancer[J].Tech Coloproctol,2018,22(9):725
[30]Yuan X,Zhang B,Hu C,et al.Retrolaparoscopic adrenalectomy assisted by three-dimensional reconstructed digital model in a patient with situs inversus totalis[J].World J Surg Oncol,2018,16(1):173
[2]Qiu M,Xiang J J,Ma L L,et al.Analysis of the curative effect of laparoscopic partial nephrectomy for complete endogenetic renal tumor after real-time ultrasonic monitoring[J].Chinese Department of Urology,2016,37(10):730-734
[3]Wang X L,Jiang F Q,Zhang G,et al.Comparison of the safety and efficacy of laparoscopic and open nephrectomy for the treatment of localized renal cancer in elderly patients[J].Chinese gerontology,2016,36(5):1122-1124
[4]Ma J J,Zhang L y,Zang L,et al.Analysis of the long-term effect and prognostic factors of laparoscopic T4a stage radical gastrectomy for gastric cancer[J].Chinese Journal of digestive surgery,2017,12(12):1210-1216
[5]Chen Q y,Lv Ch B,Zheng Zh H,et al.Analysis of the efficacy of laparoscopic assisted radical gastrectomy for the treatment of Siewert II,type III gastroesophageal junction adenocarcinoma[J].Chinese Journal of Practical Surgery,2016,36(9):995-1000
[6]Chen Y R,Zhang Y,Wu H S,et al.Comparison of the safety and survival outcome of laparoscopy and laparotomy in the abdominal paraaortic lymph node dissection in cervical cancer[J].modern obstetrics and Gynecology,2017,26(10):727-730
[7]Porpiglia F,Fiori C,Bertolo R,et al.Long-term functional evaluation of the treated kidney in a prospective series of patients who underwent laparoscopic partial nephrectomy for small renal tumors[J].European Urology,2016,62(1):130-135
[8]Liu X,Pan X W,Yang Q W,et al.The improvement and efficacy of retroperitoneal laparoscopic partial nephrectomy for moderate complex renal cell carcinoma(report of 84 cases)[J].Clinical department of Urology,2016,15(6):533-537
[9]Hirono M,Kobayashi M,Tsushima T,et al.Impacts of clinicopathologic and operative factors on short-term and long-term sur vival in renal cell carcinoma with venous tumor thrombus extension:a multiinstitutional retrospective study in Japan[J].Bmc Cancer,2016,13(1):447-449
[10]Jiang G S,Li W Ch,Chen Zh H,et al.Influence of endogenous growth characteristics of renal tumors on the short-term efficacy of robotic assisted laparoscopic partial nephrectomy[J].Chinese Department of Urology,2017,38(3):166-169
[11]Gao H J,Wu D P,Zhu G D,et al.The safety and efficacy of retroperitoneal laparoscopic partial nephrectomy and partial nephrectomy for localized renal carcinoma[J].Modern department of Urology journal,2016,21(3):182-186
[12]Chen F,Xiong W,Du Y Ch,et al.The clinical observation and prognostic factors of small abdominal incision combined with retroperitoneoscopy in the treatment of renal pelvis cancer[J].Liberation Army Medical Journal,2017,29(3):35-38
[13]Chen W,Chen Y H,Zhang J,et al.The short-term efficacy of laparoscopic and open nephrectomy for the treatment of T_(1b)stage renal carcinoma[J].Journal of clinical department of Urology,2017,10(5):339-343
[14]Han G,Gong H J,Wang Y D,et al.A comparative analysis of gastrointestinal function and long-term prognosis in laparoscopic and open colorectal cancer radical surgery[J].Laparoscopic Surgery Journal,2016,12(6):433-436
[15]Zhang X M,Zhang D X,Cui X G,et al.Study on the safety and effectiveness of retroperitoneal laparoscopic partial nephrectomy for endogenetic renal carcinoma[J].Zhejiang clinical medicine,2017,12(8):1188-1190
[16]Ren T,Liu Y,Zhao X,et al.Transperitoneal Approach versus Retroperitoneal Approach:A Meta-Analysis of Laparoscopic Partial Nephrectomy for Renal Cell Carcinoma[J].Plos One,2017,9(3):e91978-e91980
[17]Zhang D X,Li X G,Cui X G,et al.The application of retroperitoneal laparoscopic partial nephrectomy in patients with moderate risk of renal cancer PADUA[J].Chinese Journal of surgery,2016,50(10):905-908
[18]Kim J H,Yong H P,Yong J K,et al.Perioperative and long-term renal functional outcomes of robotic versus laparoscopic partial nephrectomy:a multicenter matched-pair comparison[J].World Journal of Urology,2017,33(10):1579-1584
[19]He T,Y J J,Jia Zh K,et al.Comparison of the effect of retroperitoneal laparoscopic enucleation of renal carcinoma and traditional partial nephrectomy of renal tumor[J].Henan medical study,2016,23(2):71-73
[20]Wu Q,Zhang H.Carbon dioxide pneumothorax following retroperitoneal laparoscopic partial nephrectomy:a case report and literature review[J].BMC Anesthesiol,2018,18(1):202
[21]George T,Williams EH,Franklin R,et al.Two-Team Surgical Approach to Improve Retroperitoneal Nerve Identification in the Treatment of Groin Pain[J].Ann Plast Surg,2019,82(1):82-84
[22]Khan MA,Kahaleh M,Khan Z,et al.Time for a Changing of Guard:From Minimally Invasive Surgery to Endoscopic Drainage for Management of Pancreatic Walled-off Necrosis[J].J Clin Gastroenterol,2019,53(2):81-88
[23]Acosta R V,Ladjevardi S,Brekkan E,et al.Periprocedural outcome after laparoscopic partial nephrectomy versus radiofrequency ablation for T1 renal tumors:a modified R.E.N.A.L nephrometry score adjusted comparison[J].Acta Radiologica,2018:284185118780891
[24]Garzon S,Raffaelli R,Montin U,et al.Primary hepatic pregnancy:report of a case treated with laparoscopic approach and review of the literature[J].Fertil Steril,2018,110(5):925-931
[25]Tay WK,Kesavan A.Goh YSBRight Living Donor Nephrectomies:Retroperitoneoscopic vs Laparoscopic Transperitoneal Approach[J].Transplant Proc,2018,50(8):2333-2337
[26]Zhang L,Gao M,Zhang,et al.Surgical management of retroperitoneal schwannoma complicated with severe hydronephrosis:A case report[J].Medicine(Baltimore),2018,97(39):e12528
[27]Chen Q,Shuai X,Chen L.Safety and feasibility of the combined medial and caudal approach in laparoscopic D3 lymphadenectomy plus complete mesocolic excision for right hemicolectomy in the treatment of right hemicolon cancer complicated with incomplete ileus[J].Zhonghua Wei Chang Wai Ke Za Zhi,2018,21(9):1039-1044
[28]Limbachia D,Gandhi P.Laparoscopic retrieval of a foreign body(broken surgical knife)from retroperitoneal space:An interesting case[J].Gynecol Minim Invasive Ther,2017,6(4):193-194
[29]Ielpo B,SimóV,Pastor E,et al.Combined transanal minimally invasive surgery(TAMIS)and retroperitoneal laparoscopy for resection of lymph node recurrence of ovarian cancer[J].Tech Coloproctol,2018,22(9):725
[30]Yuan X,Zhang B,Hu C,et al.Retrolaparoscopic adrenalectomy assisted by three-dimensional reconstructed digital model in a patient with situs inversus totalis[J].World J Surg Oncol,2018,16(1):173