CAJ | 학술논문

目的探讨后腹腔镜肾部分切除术在PADUA评分为中危肾癌患者中的应用价值.方法回顾性分析2005年4月至2011年6月79例就诊于第二军医大学附属长征医院泌尿外科的PADUA评分为中危(8～9分)肾癌患者的临床资料,其中男性48例,女性31例,平均年龄(54±9)岁.肿瘤平均直径(2.8 ±0.8)cm,其中左侧37例,右侧42例；腹侧35例,背侧44例.术前影像学检查提示肿瘤侵犯集合系统13例,累及肾窦5例,靠近肾门血管10例.79例患者均行后腹腔镜肾部分切除术.结果所有手术均顺利完成,无中转开放者,围手术期未出现严重并发症.手术时间80～180 min,中位数115 min,术中平均热缺血时间(20 ±5) min,术中平均出血量(24±8)ml,术后平均住院时间(5.2±1.5)d.术后出现尿漏3例,留置导尿及输尿管导管后1周症状消失；术后肌酐短暂升高7例,均在6周内降至正常范围；术后平均随访(34±12)个月(10 ～ 84个月),77例患者术后6个月预估肾小球率过滤(eGFR)较术前无统计学意义,另2例患者eGFR分别下降30％、35％；术后肾功能长期维持在慢性肾功能不全3期和2期患者各2例,均未行血液透析治疗,余患者未发生肾功能不全；所有患者随访期间未见肿瘤复发及转移.结论后腹腔镜肾部分切除术治疗PADUA评分为中危肾癌安全、有效,但其远期疗效尚需大样本对照研究和长期随访观察.
목적 탐토후복강경신부분절제술재PADUA평분위중위신암환자중적응용개치.방법 회고성분석2005년4월지2011년6월79례취진우제이군의대학부속장정의원비뇨외과적PADUA평분위중위(8～9분)신암환자적림상자료,기중남성48례,녀성31례,평균년령(54±9)세.종류평균직경(2.8 ±0.8)cm,기중좌측37례,우측42례；복측35례,배측44례.술전영상학검사제시종류침범집합계통13례,루급신두5례,고근신문혈관10례.79례환자균행후복강경신부분절제술.결과 소유수술균순리완성,무중전개방자,위수술기미출현엄중병발증.수술시간80～180 min,중위수115 min,술중평균열결혈시간(20 ±5) min,술중평균출혈량(24±8)ml,술후평균주원시간(5.2±1.5)d.술후출현뇨루3례,류치도뇨급수뇨관도관후1주증상소실；술후기항단잠승고7례,균재6주내강지정상범위；술후평균수방(34±12)개월(10 ～ 84개월),77례환자술후6개월예고신소구솔과려(eGFR)교술전무통계학의의,령2례환자eGFR분별하강30％、35％；술후신공능장기유지재만성신공능불전3기화2기환자각2례,균미행혈액투석치료,여환자미발생신공능불전；소유환자수방기간미견종류복발급전이.결론 후복강경신부분절제술치료PADUA평분위중위신암안전、유효,단기원기료효상수대양본대조연구화장기수방관찰.
Objective To study the application of retroperitoneal laparoscopic partial nephrectomy in renal carcinoma patients with intermediate risk PADUA score.Methods From April 2005 to June 2011,79 cases (48 males and 31 females) of intermediate risk PADUA score (range from 8 to 9 score) renal cell carcinoma were retrospectively analyzed. Mean age was ( 54 ± 9 ) years,mean tumor size was (2.8 ±0.8) cm in diameter,with 37 cases on the left side and 42 cases on the right side.Tumor located anteriorly in 35 cases,and 44 cases were located posteriorly.Preoperative imaging examinations showed tumor invasion of the collecting system was dislocated or infiltrated by tumor invasion were in 13 cases,renal sinus were involved in 5 cases,tumor located near the renal hilum were in 10 cases. All of the 79 patients received retroperitoneal laparoscopic partial nephrectomy.Results The 79 cases were operated successfully without conversion to open surgery,no severe perioperative complications.The mean operation time was (105 ± 24)minutes,and the median of operation time was 115 minutes (range from 80-180 minutes),and mean warm ischemia time (WIT) was (20 ± 5) minutes,and mean blood loss was (24 ± 8) ml; mean postoperative hospital stay was (5.2 ± 1.5 ) days.Postoperative urinary leakage in 3 cases,symptoms disappeared one week after indwelling catheterization and ureteral catheter. Serum creatinine transient increased in 7 cases after surgery,and fell to normal range within 6 weeks.In a mean follow up for (34 ± 12) months (range from 10 to 84 months),estimated glomerular filtration rate (eGFR) 6 months after operation was no statistical significance compared with preoperation in 77 cases,another 2 patients' eGFR decreased by 30％and 35％. Postoperative renal function remained in CKD3 period and CKD2 period were in 2 cases respectively,none of these cases were treated with hemodialysis,and the remaining patients with normal renal function after surgery,no tumor recurrence and metastasis during follow-up in all cases.Conclusions Treatment of retroperitoneal laparoscopic partial nephrectomy in renal carcinoma patients with intermediate risk PADUA score is safe and effective,but its long-term effects still need to study with large samples compare and long-term follow-up.