肾脏部分切除手术对T1a期肾癌患者肾脏的影响

Effects of partial nephrectomy on renal functions of patients with T1a renal cell carcinoma

摘要:

目的  探讨肾脏部分切除手术对T1a期肾癌患者肾脏的影响，为其临床应用提供依据。方法  选择80例诊断为T1a期肾癌患者作为研究对象，采用随机数字表法将患者分为部分切除术组与根治术组，分别给予部分切除术与根治性肾切除术治疗。随访12个月，比较两组患者肾功能差异。结果  部分切除组手术时间高于根治术组，差异有统计学意义（P <0.05）；术中出血量比较差异无统计学意义（P >0.05）。术后两组患者肾小球滤过率（GFR）及内生肌酐清除率（Ccr）明显降低，而尿素氮（BUN）则升高，术后3个月逐渐恢复，且随访12个月无明显改变，保持稳定水平。术后3、6和12个月部分切除组GFR、Ccr高于同期根治术组，而BUN低于同期根治术组，差异有统计学意义（P <0.05）。结论  对T1a期肾癌，肾部分切除术能更好地保留肾功能，其肾功能不全发生率亦比较低，是治疗T1a期肾癌的有效手术方式。

Abstract:

Objective To study the effects of partial nephrectomy on the renal functions of patients with T1a renal cell carcinoma. Methods Eighty patients with T1a renal cell carcinoma were included. They were divided into partial-nephrectomy group and radical-nephrectomy group according to the stochastic indicator method. Renal functions were compared between both groups after 12-month follow-up. Results The operation time in the partial-nephrectomy group was significantly longer than that in the radical-nephrectomy group (P < 0.05). There was no difference in intraoperative blood loss between the two groups (P > 0.05). Glomerular filtration rate (GFR) and endogenous creatinine clearance (Ccr) significantly decreased, while urea nitrogen (BUN) increased after operation in both groups. Three months after operation, GFR, Ccr and BUN gradually recovered, and had no apparent change thereafter during follow-up. GFR and Ccr were significantly higher in the partial-nephrectomy group 3, 6 and 12 months after operation than those in the radical-nephrectomy group at the corresponding time (P < 0.05). BUN in the partial-nephrectomy group 3, 6 and 12 months was lower than that in the radical-nephrectomy group at the corresponding time, the differences were statistically significant (P < 0.05). Conclusions The partial nephrectomy can keep better renal function with a lower incidence of renal insufficiency, which is an effective surgical treatment for stage T1a renal cancer.