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目的:比较后腹腔镜手术与开放性手术治疗T2期及以上肾癌(肿瘤体积>7cm)的疗效。方法:回顾性分析2012年1月~2015年1月经手术治疗的57例大体积肾癌(>7cm)患者的临床资料。男34例,女23例,年龄44~72岁,平均(58.2±7.0)岁。肿瘤直径7.0~12.2cm,平均(8.8±1.2)cm。肿瘤位于左侧30例,右侧27例。术前临床分期T2~T3期。所有患者均行根治性肾切除术,26例采用后腹腔镜手术(研究组),31例采用开放性手术(对照组)。排除下腔静脉瘤栓形成,术前淋巴结及远处转移、多发肿瘤患者。两组患者的年龄、性别、肿瘤大小和位置等临床资料比较均差异无统计学意义(P>0.05)。比较两组手术时间、出血量、输血率、术后并发症发生率、术后住院时间、随访情况等。结果:研究组1例中转开放手术。研究组与对照组的手术时间分别为(115.0±23.1)min和(132.2±28.4)min,术后排气时间分别为(1.7±0.6)d和(2.3±0.6)d,均差异有统计学意义(P<0.05)。两组在术中出血量、输血率、术后并发症发生率、术后住院时间等方面比较均差异无统计学意义(P>0.05)。术后病理均诊断为肾透明细胞癌,病理分期研究组T2期21例,T3a期5例;对照组T2期25例,T3a期6例。术后随访4~40个月,平均19个月,中位时间20个月。研究组平均生存期为17.5个月,对照组为18.2个月;研究组无疾病进展生存期平均为15.5个月,对照组为16.9个月。Cox风险分析结果显示,在年龄、性别、手术方式、肿瘤分期四个因素,只有肿瘤分期是总体生存期(P=0.018)和无疾病进展生存期(P=0.020)的独立危险因素。手术方式不是独立危险因素(P=0.312;P=0.331)。结论:后腹腔镜手术治疗大体积肾癌安全、可行、有效。后腹腔镜手术较开放手术手术时间短、术后恢复快。手术方式不是患者总体生存期和无疾病生存期的独立危险因素。
Objective: To compare the efficacy of retroperitoneal laparoscopic surgery and open surgery in the treatment of T2 and above renal cell carcinoma (tumor volume> 7cm). Methods: The clinical data of 57 patients with large renal cell carcinoma (> 7cm) surgically treated from January 2012 to January 2015 were retrospectively analyzed. 34 males and 23 females, aged 44 to 72 years, with an average (58.2 ± 7.0) years. Tumor diameter 7.0 ~ 12.2cm, with an average (8.8 ± 1.2) cm. The tumors were located on the left side in 30 cases and on the right side in 27 cases. Preoperative clinical stage T2 ~ T3 period. All patients underwent radical nephrectomy, 26 patients underwent retroperitoneal laparoscopic surgery (study group) and 31 patients underwent open surgery (control group). Exclusion of inferior vena cava thrombus formation, preoperative lymph node and distant metastasis, multiple tumor patients. Two groups of patients age, gender, tumor size and location and other clinical data were no significant difference (P> 0.05). The operation time, blood loss, blood transfusion rate, incidence of postoperative complications, postoperative hospital stay, follow-up and so on were compared between the two groups. Results: One case of study group was transferred to open surgery. The operative time of the study group and the control group were (115.0 ± 23.1) min and (132.2 ± 28.4) min, and the postoperative exhaust time was (1.7 ± 0.6) d and (2.3 ± 0.6) d, respectively Significance (P <0.05). There was no significant difference in bleeding volume, blood transfusion rate, postoperative complication rate and postoperative hospital stay between the two groups (P> 0.05). Postoperative pathology was diagnosed as clear cell renal cell carcinoma, pathological staging study group T2 in 21 cases, T3a in 5 cases; control group T2 in 25 cases, T3a in 6 cases. The patients were followed up for 4 to 40 months with an average of 19 months and a median time of 20 months. The average survival time was 17.5 months in the study group and 18.2 months in the control group. The average progression-free survival time was 15.5 months in the study group and 16.9 months in the control group. Cox risk analysis showed that only tumor staging was an independent risk factor for overall survival (P = 0.018) and disease-free survival (P = 0.020) in terms of age, gender, surgical modality and tumor stage. Surgical procedures were not independent risk factors (P = 0.312; P = 0.331). Conclusion: Retroperitoneal laparoscopic surgery is safe, feasible and effective in treating massive renal cell carcinoma. Retroperitoneal laparoscopic surgery is shorter than open surgery, postoperative recovery fast. Surgical procedure is not an independent risk factor for overall patient survival and disease-free survival.