腹腔镜下冷冻消融与肾部分切除术治疗肾细胞癌的临床效果比较

摘要

Objective To compare the clinical outcomes of laparoscopic cryoablation(LCA)and laparoscopic partial nephrectomy(LPN)in the treatment of renal cell carcinoma(RCC).Methods Between April 2005 and March 2009,47 patients were treated with minimally invasive nephron sparing surgery(LPN or LCA)for RCC.The LCA group included 18 selected primary RCC cases(14 men and 4 women,mean age 63 years).There were 6 tumors located in the left,11 located in the right and 1 located bilaterally.The maximum diameter of tumors wag 1.5-5.0 cm(mean:2.9 cm).The LPN group included 29 renal tumors patients(19 men and 10 women,mean age 61 years).The maximum diameter of tumors in this group was 2.0-4.5 cm(mean:2.8 cm).Changes of hemoglobin(Hb),erythrocyte sedimentation rate(ESR),serum creatinine(SCr)and glomerular filtration rate(GFR)after operations were compared between LCA group and LPN group.The operative time,average intra-operative bleeding volume,postoperative hospital stay and incidence of postoperative complications of the 2 groups were analyzed and compared.Results The 2 surgical procedures were both successfuI.There was no significant change of Hb,ESR,SCr and GFR after operations in LCA group and LPN group(P＞0.05).The operative time was(94±29)min and (146±45)min in LCA group and LPN group,respectively.The average estimated blood loss was (37±20)ml and(274±69)ml.The postoperative hospital stay was(4±2)d and(10±2)d.These differences between the 2 groups were significant(P＜0.01).No laparoscopic operative complications were noted in LCA group.Follow-up magnetic resonance imaging(MRI)at 1,3,and 6 months identified the punched-out,nonenhancing,spontaneously resorbing,renal cryolesion.LCA group had completed a minimum follow-up of 6 months(mean 16,range 6 to 21 months).No evidence of local or port-site recurrence was found,and no patient developed metastatic disease.3-36 months'(mean 20 months)follow-up showed no recurrence of tumors or metastatic disease in LPN group.Conclusions LCA for RCC is an accurate and effective intervention with a relatively low incidence of complications.and is superior to LPN in operative time,intraoperative bleeding volume and postoperative recovery.%目的 比较腹腔镜下冷冻消融(laparoscopic cryoablation,LCA)和腹腔镜下肾部分切除术(laparoscopie partial nephrectomy,LPN)治疗肾细胞癌(renal cell carcinoma,RCC)的临床疗效.方法 2005年4月至2009年3月先后采用LCA和LPN治疗RCC 47例.LCA组18例患者,男性14例,女性4例,平均63岁,19例肾癌,左侧6例,右侧11例,双侧1例.肿瘤最大径1.5～5.0 cm,平均2.9 cm.LPN组29例患者,男性19例,女性10例,平均61岁.肿瘤最大径2.0～4.5 cm,平均2.8 cm.对两组患者手术前后血红蛋白(Hb)、红细胞沉降率(ESR)、血肌酐(SCr)、患侧肾小球滤过率(GFR)及两种术式手术时间、术中平均出血量、术后住院天数、术后并发症发牛率等进行统计分析.结果 48例次手术均获成功,无中转开放.LCA组和LPN组Hb、ESR、SCr、患肾GFR较术前均无明显变化(P＞0.05).两组手术时间分别为(94±29)min和(146±45)min,术中出血量分别为(37±20)ml和(274±69)ml,术后住院天数分别为(4±2)d和(10±2)d,组间比较差异均有统计学意义(P＜0.01).LCA组术后尤明显腹腔镜相关并发症,术后第1、3和6个月分别查MRI,肾脏肿瘤冷冻区域呈梗死、无信号增强、逐渐消散等演变过程;LPN组术后出现漏尿1例,2周后自行愈合.LCA组随访6～21个月,平均16个月,均未发现局部复发或远处转移.LPN组术后随访3～36个月,平均27个月,均未见肿瘤局部复发及转移.结论 LCA治疗RCC安全有效,在手术时间、术中出血量和术后恢复等方面优于LPN.