摘要
目的探讨局限性肾癌(LRCC)腹腔镜下肾部分切除术(LPN)入路选择对患者内分泌、肾功能、生存结局的影响。方法收集2021年3月至2022年9月新乡医学院第一附属医院收治的101例LRCC患者的临床资料进行回顾性研究,根据LPN入路方式分为A组(n=51)和B组(n=50),分别采取经后腹腔途径入路和经腹腔入路。比较两组患者的围术期指标、手术前后内分泌相关指标[皮质醇(COR)、促肾上腺皮质激素(ACTH)、胰岛素(Ins)、去甲肾上腺素(NE)]、肾功能指标[血肌酐(Scr)、尿素氮(BUN)、肾小球滤过率(eGFR)],同时比较两组患者术后并发症、术后12个月生存率和局部复发率。结果A组患者的手术时间、胃肠通气时间、住院时间分别为(101.12±13.34)min、(7.88±1.34)h、(7.81±1.34)d,明显短于B组的(138.38±18.99)min、(10.36±1.59)h、(10.43±1.68)d,差异均有统计学意义(P<0.05);术后3 d,A组患者的血清COR、ACTH、NE分别为(18.89±3.38)ng/L、(40.41±5.26)ng/L、(268.68±30.13)μg/L,明显低于B组的(23.99±4.47)ng/L、(53.54±5.99)ng/L、(317.62±34.99)μg/L,Ins为(17.56±2.13)μIU/mL,明显高于B组的(13.34±1.64)μIU/mL,差异均有统计学意义(P<0.05);术后3 d、5 d、1个月、6个月和12个月,两组患者的BUN、e GFR、Scr比较差异均无统计学意义(P>0.05);两组患者术后并发症总发生率及术后12个月生存率、局部复发率比较,差异均无统计学意义(P>0.05)。结论腹腔镜下LPN经后腹腔途径入路、经腹腔入路是LRCC患者安全性可靠的治疗方案,均能改善患者肾功能,且具有较好的生存获益,而经后腹腔途径入路手术能优化手术流程,可减轻对患者机体内分泌环境的影响,促进术后早期恢复。
Objective To investigate the influence of the selection of laparoscopic partial nephrectomy(LPN)approach on endocrine,renal function,and survival outcomes in patients with localized renal cell carcinoma(LRCC).Methods The clinical data of 101 patients with LRCC who were admitted to the First Affiliated Hospital of Xinxiang Medical University from March 2021 to September 2022 were collected for retrospective study.The patients were divided into group A(n=51)and group B(n=50)according to the LPN approach.which were treated with retroperitoneal approach and transperitoneal approach,respectively.The perioperative indicators,endocrine-related indicators[cortisol(COR),adrenocorticotropic hormone(ACTH),insulin(Ins),norepinephrine(NE)],renal function indicators[blood creatinine(Scr),blood urea nitrogen(BUN),glomerular filtration rate(eGFR)]before and after surgery were compared between the two groups,and the postoperative complications,12-month survival rate,and local recurrence rate were also compared.Results The operation time,gastrointestinal ventilation time,and length of hospital stay in group A were(101.12±13.34)min,(7.88±1.34)h,and(7.81±1.34)d,respectively,which were significantly shorter than(138.38±18.99)min,(10.36±1.59)h,and(10.43±1.68)d in group B(P<0.05).Three days after surgery,the serum COR,ACTH,and NE levels in group A were(18.89±3.38)ng/L,(40.41±5.26)ng/L,and(268.68±30.13)μg/L,respectively,which were significantly lower than(23.99±4.47)ng/L,(53.54±5.99)ng/L,and(317.62±34.99)μg/L in group B(P<0.05).There were no significant differences in BUN,eGFR,and Scr between the two groups at 3 d,5 d,1 month,6 months,and 12 months after operation(P>0.05).There were no significant differences in the total incidence of postoperative complications,12-month survival rate,and local recurrence rate between the two groups(P>0.05).Conclusion Laparoscopic LPN via retroperitoneal approach and transperitoneal approach are both safe and reliable treatment options for LRCC patients,which can improve the renal function
作者
张冠英
徐云
马阔
吴春磊
余沁楠
ZHANG Guan-ying;XU Yun;MA Kuo;WU Chun-lei;YU Qin-nan(Department of Urology,the First Affiliated Hospital of Xinxiang Medical University,Xinxiang 453100,Henan,CHINA;Department of Endocrinology,the First Affiliated Hospital of Xinxiang Medical University,Xinxiang 453100,Henan,CHINA)
出处
《海南医学》
CAS
2024年第13期1844-1848,共5页
Hainan Medical Journal
基金
新乡医学院第一附属医院博士科研基金(编号:xyyfy2014BS-003)。
关键词
肾癌
局限性
手术入路
内分泌
肾功能
并发症
生存率
复发率
Renal carcinoma
Limitations
Surgical approach
Endocrine
Renal function
Complications
Survival rate
Recurrence rate
