本文選題：腎細(xì)胞癌　切入點(diǎn)：腎部分切除術(shù)　出處：《鄭州大學(xué)》2014年碩士論文

【摘要】：目的 評價(jià)保留腎單位手術(shù)治療T1b期腎癌的安全性與可行性。 方法 回顧性對照研究2007年1月至2009年1月鄭州大學(xué)第一附屬醫(yī)院泌尿外科131例T1b期腎癌的臨床資料，其中行保留腎單位手術(shù)治療者64例，行根治性腎切除術(shù)治療者67例。統(tǒng)計(jì)分析兩組患者年齡、性別、腫瘤位置分布、腫瘤最大直徑、手術(shù)時(shí)間、術(shù)中出血量、術(shù)后引流量、術(shù)后引流管留置時(shí)間、術(shù)后胃腸功能恢復(fù)時(shí)間、術(shù)后住院天數(shù)、術(shù)后并發(fā)癥、術(shù)后腎功能變化、術(shù)后腎小球?yàn)V過率變化、腫瘤復(fù)發(fā)情況、保留腎單位手術(shù)腎臟血流阻斷時(shí)間及切緣陽性率、術(shù)后腫瘤控制率等指標(biāo)的差異有無統(tǒng)計(jì)學(xué)意義，評價(jià)保留腎單位手術(shù)治療T1b期腎癌的安全性與可行性。 結(jié)果 1．保留腎單位手術(shù)組與根治性腎切除術(shù)組在輸血率、胃腸恢復(fù)時(shí)間、術(shù)后住院時(shí)間、引流管留置時(shí)間差異無統(tǒng)計(jì)學(xué)意義(P＞0.05)；保留腎單位手術(shù)組與根治性腎切除術(shù)組手術(shù)時(shí)間、術(shù)中出血量、術(shù)后引流量、并發(fā)癥發(fā)生率差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。 2．保留腎單位手術(shù)組患者術(shù)后5年血清肌酐水平（SCr）較術(shù)前均升高，但配對t檢驗(yàn)，兩者差異無統(tǒng)計(jì)學(xué)意(P0.05)；根治性腎切除術(shù)組患者術(shù)后5年血清肌酐水平（SCr）較術(shù)前均升高，配對t檢驗(yàn)，差異有統(tǒng)計(jì)學(xué)意義(P0.05)。分別比較保留腎單位手術(shù)組患者術(shù)前、術(shù)后5年的總腎小球?yàn)V過率、患側(cè)腎小球?yàn)V過率、健側(cè)腎小球?yàn)V過率差異無統(tǒng)計(jì)學(xué)意義(P0.05)；分別比較根治性腎切除術(shù)組患者術(shù)前、術(shù)后5年的總腎小球?yàn)V過率、健側(cè)腎小球?yàn)V過率差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。 3．在隨訪期間，，保留腎單位手術(shù)組64例T1b期腎癌患者中有2例復(fù)發(fā)，復(fù)發(fā)率3.12%；根治性腎切除術(shù)中有2例復(fù)發(fā)，復(fù)發(fā)率為2.98%，比較兩組患者術(shù)后腫瘤復(fù)發(fā)率差異無統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論 T1b腎癌行保留腎單位手術(shù)與根治性腎切除術(shù)具有相似的腫瘤控制率，但在保護(hù)腎功能方面明顯優(yōu)于根治性腎切除術(shù)。位于腎臟兩極、遠(yuǎn)離腎門、位置表淺、腫瘤相對較小、外生性生長、未侵犯或少量侵犯集合系統(tǒng)的T1b期腎癌建議行保留腎單位手術(shù)。切緣陰性、保護(hù)腎功能且無并發(fā)癥是保留腎單位手術(shù)的理想效果。
[Abstract]:Purpose. To evaluate the safety and feasibility of nephron-sparing surgery for T 1b stage renal carcinoma. Method. From January 2007 to January 2009, the clinical data of 131 cases of stage T1b renal cell carcinoma in Urology Department, first affiliated Hospital of Zhengzhou University, were retrospectively studied. Among them, 64 cases were treated with nephron-sparing surgery. 67 patients were treated with radical nephrectomy. Age, sex, tumor location, tumor diameter, operation time, intraoperative bleeding volume, postoperative drainage volume, postoperative drainage tube indwelling time were statistically analyzed. Postoperative gastrointestinal function recovery time, postoperative hospitalization days, postoperative complications, postoperative changes of renal function, changes of glomerular filtration rate, recurrence of tumor, renal blood flow occlusion time and positive rate of incision margin in nephron-sparing surgery were analyzed. To evaluate the safety and feasibility of renal unit sparing surgery in the treatment of stage T 1b renal carcinoma. Results. 1. There was no significant difference in blood transfusion rate, gastrointestinal recovery time, postoperative hospitalization time and drainage tube indwelling time between the nephrectomy group and the radical nephrectomy group (P > 0.05), but the operative time between the nephron sparing operation group and the radical nephrectomy group was not significant (P > 0.05). There were significant differences in intraoperative bleeding, postoperative drainage and complications (P < 0.05). 2. The serum creatinine level in the nephrectomy group was significantly higher than that in the preoperative group, but there was no significant difference between the two groups in the paired t test (P 0.05), and the serum creatinine level in the radical nephrectomy group was higher than that in the preoperative group. The total glomerular filtration rate and the glomerular filtration rate of the patients in the nephron sparing operation group were compared 5 years before and 5 years after operation respectively. There was no significant difference in the glomerular filtration rate between the two groups (P < 0.05), and the total glomerular filtration rate in the radical nephrectomy group was significantly higher than that in the control group (P < 0.05), and the total glomerular filtration rate in the control group was significantly higher than that in the control group (P < 0.05). 3. During the follow-up period, in the nephron-sparing surgery group, 2 cases recurred in 64 cases of stage T1b renal carcinoma, and 2 cases in radical nephrectomy, the recurrence rate was 2.98%. There was no significant difference in the recurrence rate of tumor between the two groups (P 0.05). Conclusion. The tumor control rate of T1b renal carcinoma undergoing nephron-sparing surgery is similar to that of radical nephrectomy, but it is superior to radical nephrectomy in protecting renal function. Stage T1b renal cell carcinoma with ectogenic growth, no invasion or little invasion of the aggregate system is recommended to undergo nephron sparing surgery. Negative margin, protection of renal function and no complications are the ideal results of nephron-sparing surgery.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R737.11

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