| 摘要: |
| 目的 比较单孔腹腔镜根治性肾切除术（LESS-RN）与传统腹腔镜根治性肾切除术（CL-RN）后至少10年的局限性肾癌患者肿瘤疗效和肾功能结局。方法 选取2009—2012年在海军军医大学（第二军医大学）第一附属医院接受LESS-RN或CL-RN治疗的T1a～T2a期局限性肾癌患者，按患者年龄、BMI、肿瘤大小进行倾向评分匹配，共纳入31对患者，分析患者的基线特征、手术数据、病理结果和随访信息，以评估LESS-RN和CL-RN的长期预后差异。结果 LESS-RN组与CL-RN组患者在手术时间［（179.7±43.0）min vs （172.6±50.9）min，P＝0.349］、估计失血量［100（50，200）mL vs 100（50，150）mL，P＝0.871］、住院时间［6（5，7）d vs 7（6，9）d，P＝0.080］方面差异均无统计学意义。LESS-RN组有1例患者发生术中并发症，没有患者发生术后并发症；CL-RN组有1例患者发生术中并发症，3例患者发生术后并发症。LESS-RN组随访时间为（138.0±9.0）个月，CL-RN组为（137.8±9.8）个月（P＝0.730）。LESS-RN组与CL-RN组患者总生存率（80.6% vs 74.2%，P＝0.181）、肿瘤特异性生存率（93.6% vs 96.8%，P＝0.554）、血肌酐变化水平［32（17，45）μmol/L vs 20（5，47）μmol/L，P＝0.098］和估算的肾小球滤过率［（60.2±20.9）mL·min-1·（1.73 m2）-1 vs （66.7±27.8）mL·min-1·（1.73 m2）-1，P＝0.342］差异均无统计学意义。结论 LESS-RN是一种安全、可行的治疗局限性肾癌的手术方法，其长期肿瘤疗效和肾功能结局与CL-RN相当。 |
| 关键词: 肾肿瘤 肾细胞癌 单孔腹腔镜 腹腔镜肾切除术 根治性肾切除术 |
| DOI：10.16781/j.CN31-2187/R.20240058 |
| 投稿时间：2024-01-21修订日期：2024-02-05 |
| 基金项目:国家自然科学基金（82072825，81874093，82373253），上海市曙光计划（22SG35），上海市“医苑新星”人才培养计划（2020YYXX），上海市重中之重研究中心建设项目（2022ZZ01011）. |
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| Laparoendoscopic single-site nephrectomy compared with conventional laparoscopic nephrectomy for localized renal cancer: a matched-pair comparison with at least 10-year follow-up |
| SONG Jiaao,LIU Wenqiang,CHEN Tong,WU Xiaofeng,XU Hong,WU Zhenjie,WANG Linhui* |
(Department of Urology, The First Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To compare the tumor and renal function outcomes of patients with localized renal cancer at least 10 years after laparoendoscopic single-site radical nephrectomy (LESS-RN) or conventional laparoscopic radical nephrectomy (CL-RN). Methods Totally 31 pairs of T1a-T2a localized renal cancer patients treated with LESS-RN or CL-RN in The First Affiliated Hospital of Naval Medical University (Second Military Medical University) during 2009-2012 were matched by age, body mass index, and tumor size. Baseline characteristic, surgical data, pathological results, and follow-up information were analyzed to evaluate the long-term outcomes between the 2 groups. Results There were no significant differences between the LESS-RN and CL-RN groups in operative time (［179.7±43.0］ min vs ［172.6±50.9］ min, P＝0.349), estimated blood loss (100［50, 200］mL vs 100［50, 150］mL, P＝0.871), or hospital stay (6［5, 7］d vs 7［6, 9］d, P＝0.080). Only 1 intraoperative complication occurred in both groups, while no postoperative complication occurred in the LESS-RN group and 3 in the CL-RN group. The follow-up time was (138.0±9.0) months in the LESS-RN group and (137.8±9.8) months in the CL-RN group (P＝0.730). The overall survival rate (80.6% vs 74.2%, P＝0.181), cancer-specific survival rate (93.6% vs 96.8%, P＝0.554), change in creatinine level (32 ［17, 45］ μmol/L vs 20［5, 47］μmol/L, P＝0.098) or estimated glomerular filtration rate (［60.2±20.9］mL·min-1· (1.73 m2)-1 vs［66.7±27.8］mL·min-1·(1.73 m2)-1, P＝0.342) were not significantly different between the 2 groups. Conclusion LESS-RN is a safe and feasible surgical method for localized renal cancer with long-term tumor efficiency and renal function outcomes comparable to CL-RN. |
| Key words: kidney neoplasms renal cell carcinoma single-site laparoscopy laparoscopic nephrectomy radical nephrectomy |
