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单孔腹腔镜与传统腹腔镜肾切除术治疗局限性肾癌的疗效比较:术后随访至少10年的配对研究
宋家璈,柳文强,陈童,吴小凤,徐红,吴震杰,王林辉*
0
(海军军医大学(第二军医大学)第一附属医院泌尿外科, 上海 200433
*通信作者)
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 m2-1P=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).
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