Analysis of the efficacy of laparoscopic partial nephrectomy in the treatment of completely endophytic renal tumors by ultrasound monitoring
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摘要: 目的 探讨超声监测下腹腔镜肾部分切除术治疗完全内生性肾肿瘤的安全性和疗效。方法 分析2014年2月—2021年3月上海交通大学附属第六人民医院收治的18例完全内生性肾肿瘤的临床资料、术中情况、术后随访等。随机选取该期间收治的20例T1a外生性肾肿瘤作为对照。结果 2组患者均顺利接受腹腔镜肾部分切除术，无中转开放或者肾切除手术，均完整切除肾肿瘤，其中内生性肾肿瘤患者在术中超声监测下行腹腔镜肾部分切除手术。内生肿瘤组的手术时间和热缺血时间分别为(161.4±22.5) min和(23.0±2.1) min，外生肿瘤组分别为(122.6±27.3) min和(18.4±2.6) min，2组比较差异有统计学意义(P< 0.05)。但在肿瘤切缘、术中出血量、术后住院时间及并发症方面，2组比较差异无统计学意义(P>0.05)。所有患者均获得随访，平均随访时间46.3个月。术后患肾GFR下降方面比较，2组差异无统计学意义。内生性肿瘤组1例术后出现肾肿瘤复发; 外生性肿瘤组1例术后出现肿瘤复发。2组患者均生存，无转移。结论 腹腔镜肾部分切除术是治疗完全内生性肾肿瘤的安全、有效方法。术中超声监测是完整切除内生性肾肿瘤，最大限度保护肾功能的关键，获得与外生性肾肿瘤相同的疗效。Abstract: Objective To explore the safety and efficacy of the treatment of aparoscopic partial nephrectomy (LPN) for completely endophytic renal tumors under ultrasound monitoring.Methods We retrospectively analysed the clinical data of 18 cases of completely endophytic renal tumors admitted to our hospital from February 2014 to March 2021. Other 20 cases of T1a exophytic renal tumors treated with LPN during the period were randomly selected as a control group.Results Both groups of patients successfully underwent LPN without conversion to open surgery or radical nephrectomy. All tumors were completely resected and completely endophytic renal tumors were resected with LPN under ultrasound monitoring. The surgery time and warm ischemia time were (161.4±22.5) min and (23.0±2.1) min, respectively in the endophytic renal tumor group, while the exophytic renal tumor group were (122.6± 27.3) min and (18.4±2.6) min, respectively. The differences were statistically significant (P< 0.05). However, the differences were not statistically significant in terms of positive cancer margins, intraoperative bleeding, postoperative hospitalization time or postoperative complications (P> 0.05). All patients received follow-up, with an average follow-up time of 46.3 months. There was no statistical difference between the two groups in terms of postoperative renal GFR decline. In the endophytic renal tumor group, 1 case showed renal tumor recurrence after surgery, while in the exophytic renal tumor group, 1 case showed tumor recurrence after surgery. Both groups of patients survived without metastasis.Conclusion LPN is a safe and effective method for treating completely endophytic renal tumors. Ultrasound monitoring in surgery is the key to completely removing endophytic renal tumors and maximizing the protection of kidney function, so as to ensure the same efficacy as exophytic renal tumors.
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Key words:
- ultrasound /
- laparoscopic /
- partial nephrectomy /
- endophytic /
- renal tumor
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表 1 2组患者基本资料
X ± S 项目 内生性肿瘤组
(n=18)外生性肿瘤组
(n=20)年龄/岁 64.5±6.4 65.7±5.7 性别/例(%) 男 12(66.7) 12(60.0) 女 6(33.3) 8(40.0) 体质指数/(kg·m-2) 26.5±3.8 24.9±3.3 肿瘤位置/例(%) 左侧 11(61.1) 12(60.0) 右侧 7(38.9) 8(40.0) 合并糖尿病/例(%) 3(16.7) 5(25.0) 合并高血压/例(%) 7(38.9) 6(30.0) 肿瘤大小/cm 2.4±1.2 2.9±1.8 患肾GFR/(mL·min-1) 34.5±7.6 32.8±6.4 R.E.N.A.L.评分/分 8.3±2.5 5.5±1.3 
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表 2 2组患者术中及术后随访情况
X ± S 项目 内生性肿瘤组(n=18) 外生性肿瘤组(n=20) P值 手术时间/min 161.4±22.5 122.6±27.3 < 0.05 热缺血时间/min 23.0±2.1 18.4±2.6 < 0.05 术中出血量/mL 105.4±24.7 113.2±21.5 >0.05 术后住院时间/d 5.6±1.4 5.8±1.7 >0.05 肿瘤病理/例(%) >0.05 恶性 16(88.9) 17(85.0) 良性 2(11.1) 3(15.0) 肿瘤切缘阴性/例(%) 18(100) 20(100) >0.05 术后并发症/例(%) >0.05 发热 2(11.1) 1(5.0) 尿漏 0 0 动脉栓塞/例(%) 1(5.5) 0 GFR下降值/(mL·min-1) >0.05 术后3个月 11.6±2.6 10.3±3.8 术后6个月 5.9±1.5 5.3±2.1 肿瘤复发/例(%) 1(5.5) 1(5.0) >0.05 肿瘤转移/例(%) 0 0 >0.05
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