摘要目的 探讨肾部分切除术治疗孤立肾肾癌的安全性和临床疗效.方法 回顾性分析2011年8月至2015年11月在南京大学医学院附属鼓楼医院泌尿外科行肾部分切除术治疗的20例孤立肾肾癌患者的临床病理学资料.男性15例,女性5例,中位年龄63岁.按手术方式不同将患者分为开放组(n=9)和腹腔镜组(n=11),对两组患者进行随访.均值的比较采用独立样本t检验,率的比较采用x2检验.结果 20例患者共有肿瘤21个,最大径1.5～6.0cm,平均最大径(3.7±1.3)cm.平均手术时间(205.3 ±81.8)min,中位术中估计出血量385.6 ml(20 ～1 200) ml,术中输血5例,术后漏尿1例,均未见明显发热;透明细胞癌18例,嫌色细胞癌2例,乳头状细胞癌1例;T1 aNxM0 17例,T1 bNxM0 3例,T3NxM0 1例.1例患者失访,其余19例患者随访1～53个月,平均(21.5±16.8)个月,1例复发,未发现转移,患者均存活.术后第1天血红蛋白[(114.9±19.6)g/L]、肾小球滤过率估计值[(46.5±18.2)ml/min]较术前[(130.7±18.8) g/L、(58.0±16.4) ml/min]降低,血清肌酐较术前升高[(123.8 ±39.8)μmol/L比(90.9 ±33.2) μmol/L](P值均＜0.05),3个月后血红蛋白、血清肌酐较术前无明显变化(P＞0.05).腹腔镜组比开放组出血量少(306 ml比510 ml,t=-2.38,P=0.03)、住院时间短(15 d比21 d,t=-3.34,P=0.04)、术中肾动脉阻断时间长(25.8 min比16.5 min,t =2.60,P=0.02).结论 孤立肾肾癌行肾部分切除术治疗安全有效.开放组缺血时间短,腹腔镜组创伤小、术中出血量少、恢复快、住院时间短,两组预后无明显区别.

abstractsObjective To explore the safety and clinical efficacy of partial nephrectomy for solitary kidney tumor.Methods Twenty patients with a functional or anatomic solitary kidney who underwent nephron-sparing surgery for one or more renal masses were retrospectively analyzed.There were 15 male and 5 female patients with mean age of 63 years.Patients were divided into open partial nephrectomy (OPN)group and laparoscopic partial nephrectomy(LPN) group,the two groups were followed up.Demographic and clinical characteristics were analyzed using student t-test for continuous variables,and the x2 test for categorical variables.Results There were 21 tumors whose maximum diameter were 1.5 to 6.0 cm,the mean size was (3.7 ± 1.3) cm,mean operative time was (205.3 ± 81.8) minutes,and median estimated blood loss was 385.6 ml.Five cases accepted blood transfusion intro-operation,1 case appeared leakage of urine post-operation,none had obvious fever.Eighteen cases were clear cell carcinoma,2 cases were chromophobe renal carcinoma,1 case was papillary renal cell carcinoma.Seventeen cases were TlaNxM0,3 cases were TlbNxM0,1 case was T3NxM0.One case lost to follow up,the others had completed a mean follow-up of 21.5 months (ranging from 1 to 53 months).One case recurred,no one had metastasis,all patients were alive.The hemoglobin ((114.9 ± 19.6) g/L) and estimated glomerular filtration rate (eGFR)((46.5 ± 18.2) ml/min) of postoperative day were lesser than pre-operation ((130.7 ± 18.8) g/L,(58.0 ± 16.4) m]/min),while the serum creatinine was higher ((123.8 ± 39.8) μmol/L vs.(90.9 ±33.2) μmol/L).Three months after operation,hemoglobin,serum creatinine and eGFR had no difference with pre-operative.Compared with OPN group,LPN group gain less blood loss (306 ml vs.510 ml) (t =-2.38,P =0.03),had shorter length of stays (15 d vs.21 d) (t =-3.34,P =0.04),had longer time of renal artery clamping (25.8 min vs.16.5 min) (t =2.60,P =0.02).Conclusions Partial nephrectomy is secure and effective selection for solitary kidney tumor.The LPN has less trauma,gain less blood loss,recover faster and has shorter length of stays than the OPN,which needs shorter ischaemic time.