摘要目的 探讨腹腔镜肾癌根治术联合舒尼替尼治疗局部进展性肾癌的临床疗效.方法 回顾性分析2012年1月至2014年1月期间在本科诊治局部进展性肾癌患者47例临床资料,均先行腹腔镜根治性肾切除术治疗,术后分为A、B组,A组术后给予舒尼替尼治疗患者27例,B组术后给予IL-2治疗患者20例.观察两组患者手术时间、术中出血量、术后引流时间、术后胃肠功能恢复时间、住院时间等手术情况以及病理资料.随访13 ～ 46个月,对比两组治疗后完全缓解率、PFS等药物疗效指标和药物不良反应情况.结果 47例手术均获成功,其中12例切除患侧肾上腺,无中转开放手术者,未出现严重手术并发症.手术时间(150.3±25.4) min;术中出血量(280.6±30.4) mL;术后引流时间(7.2±1.4)d;术后肠道功能恢复时间(1.5±0.4)d;住院时间(11.8±1.7)d.A组(22例)完全缓解率高于B组(15例),差异无统计学意义(P＞0.05).A组PFS[(16.7±5.1)个月]明显长于B组[(14.2±4.6)个月],差异具有统计学意义(P＜0.05).A组(18例)Ⅰ级不良反应发生率明显高于B组(5例),差异具有统计学意义(P＜0.05).A组(7例)Ⅱ级不良反应发生率明显低于B组(13例),差异具有统计学意义(P＜0.05).结论 腹腔镜根治性肾切除术联合舒尼替尼治疗局部进展性肾癌安全、有效,有利于改善患者预后水平,值得临床推广应用.

abstractsObjective To evaluate the clinical efficacy of laparoscopic radical nephrectomy combined with sunitinib for the treatment of locally advanced renal cell carcinoma.Methods The clinical data of 47 cases of locally advanced renal cell carcinoma treated in our institute from January 2012 to January 2014 were analyzed retrospectively.All patients were treated by laparoscopic radical nephrectomy in the first place,in which 27 cases of patients treated by sunitinib and 20 cases of patients treated by IL-2 were divided into group A and group B.The operation time,blood loss,postoperative drainage time,postoperative gastrointestinal function recovery time,hospital time and pathological data were observed in all patients.Follow-up 13-46 months,the complete remission rate,progression-free survival (PFS) and other indicators of drug efficacy and adverse drug reactions were compared between the two groups.Results All the operations were completed uneventfully without conversions to open surgery and no severe complications occurred,of which 12 cases were performed concurrent ipsilateral adrenal gland resection.The operation time was (150.3 ± 25.4) min,blood loss was (280.6 ± 30.4) mL,postoperative drainage time was (7.2 ± 1.4) d,postoperative gastrointestinal function recovery time was (1.5 ± 0.4) d,hospital stay was (11.8 ± 1.7) d.No statistical differences were detected between the two groups in complete remission rate (81.5％ vs.75.0％,P ＞ 0.05).The PFS in group A were significantly longer than in group B[(16.7 ± 5.1)months vs.(14.2 ± 4.6) months] (P ＜ 0.05).The incidence of grade Ⅰ adverse reactions in group A were significantly higher than in group B (66.7％ vs.25.0％,P ＜0.05).However,the incidence of grade Ⅱ adverse reactions in group A were significantly lower than group B (25.9％ vs.65.0％,P ＜ 0.05).Conclusions The laparoscopic radical nephrectomy combined with sunitinib for the treatment of locally advanced renal cell carcinoma is safe and effective,which can effectively improve the prognosis of patients with locally advanced renal cell carcinoma,it is worthy of clinical application.