【摘要】：目的:回顧性研究代謝綜合征(metabolic syndrome,MS)對腎細胞癌(renal cell carcinoma,RCC)圍手術(shù)期的術(shù)前準備、手術(shù)過程中及術(shù)后患者恢復(fù)等方面的影響,以指導臨床對合并代謝綜合征患者預(yù)后進行預(yù)測并提前干預(yù)。方法:收集自2011年1月到2017年3月期間就診于皖南醫(yī)學院附屬弋磯山醫(yī)院泌尿外科的所有TNM分期為T1、T2期的腎細胞癌患者,挑選自發(fā)現(xiàn)腎占位性病變到行根治性腎癌切除術(shù),再到術(shù)后病明確腎癌診斷全程均在我院共247例,分析所有腎癌患者的臨床資料。按患者術(shù)前是否合并代謝綜合征分為MS組(84例)、非MS(163例),對比兩組患者的年齡、術(shù)前準備時間、性別差異、臨床分期、術(shù)后病理類型及分化程度等相關(guān)指標。并針對不同手術(shù)方式分為腹腔鏡組(共104,其中MS患者38例,非MS患者66例),開放組(共143例,其中MS患者46例,非MS患者97例),比較不同術(shù)式下MS與非MS患者的手術(shù)時間、術(shù)中出血、術(shù)后腸道功能恢復(fù)時間、術(shù)后下床活動時間、術(shù)后發(fā)熱、腹膜后引流管及導尿管拔出時間、術(shù)后住院時間等指標。用SPPS19.0統(tǒng)計軟件比較不同分組間的數(shù)據(jù),T檢驗分析計量資料,2X檢驗分析計數(shù)資料,以P0.05為差異有統(tǒng)計學意義。結(jié)果:1、MS組腎癌患者的男女比例為25/29、平均年齡為55.93±10.34歲較非MS組腎癌患者男女比例132/31、平均年齡55.93±10.34歲無統(tǒng)計學差異(P0.05);術(shù)前準備時間5.47±1.52d與3.54±1.27d差異經(jīng)T檢驗具有統(tǒng)計學意義;但是通過卡方檢驗發(fā)現(xiàn)MS對臨床分期無明顯影響,差異無統(tǒng)計學意義。2、腹腔鏡手術(shù)方式下腎癌患者,MS患者的手術(shù)時間、術(shù)中出血、術(shù)后腸道功能恢復(fù)時間、術(shù)后下床活動時間、術(shù)后發(fā)熱、腹膜后引流管拔出時間、術(shù)后住院時間均較非MS患者不同,且差異具有統(tǒng)計學意義(P0.05),導尿管拔出時間無統(tǒng)計學差異;開放手術(shù)下腎癌患者,MS患者的手術(shù)時間、術(shù)中出血、術(shù)后腸道功能恢復(fù)時間、術(shù)后下床活動時間、術(shù)后發(fā)熱、腹膜后引流管拔出時間、術(shù)后住院時間均較非MS患者不同,且差異具有統(tǒng)計學意義(P0.05),導尿管拔出時間無統(tǒng)計學差異。3、透明細胞癌的患者同時伴有代謝綜合征的比例最高(67/93),乳頭細胞癌(11/54)、嫌色細胞癌(5/12),同時各種類型細胞癌占總體比例無明顯變化。透明細胞癌的Furhman分級的Ⅰ級、Ⅱ級、Ⅲ級、Ⅳ級的患者MS發(fā)生率分別為46%、53%、43%、28%。結(jié)論:MS的發(fā)生具有性別差異,同時MS對RCC圍手術(shù)期及臨床恢復(fù)具有明顯的負面影響,MS患者易發(fā)生腎透明細胞癌,然而高Furhman分級的患者并發(fā)MS風險降低,因此對于高分級的腫瘤可能與代謝性因素關(guān)系不定。
[Abstract]:Objective: to study retrospectively the effects of metabolic syndrome (metabolic syndrome,MS) on the preoperative preparation and recovery of patients with renal cell carcinoma (renal cell carcinoma,RCC) during the perioperative period. To guide the clinical prognosis of patients with metabolic syndrome and early intervention. Methods: from January 2011 to March 2017, all patients with renal cell carcinoma (RCC) with TNM staging T _ 1 and T _ 2 were selected from January 2011 to March 2017 to receive radical nephrectomy (RCC) in the Department of Urology, affiliated to Yiji Mountain Hospital of Southern Anhui Medical College. 247 cases of renal cell carcinoma were diagnosed in our hospital. The clinical data of all patients with renal cell carcinoma were analyzed. The patients were divided into MS group (84 cases) and non MS group (163 cases) according to whether the patients were complicated with metabolic syndrome before operation. The age, preparation time, sex difference, clinical stage, pathological type and differentiation degree of the two groups were compared. The patients were divided into laparoscopic group (104 cases, 38 cases of MS, 66 cases of non-MS) and open group (143 cases, including 46 cases of MS and 97 cases of non-MS). The operative time, intraoperative bleeding, postoperative intestinal function recovery time, postoperative bed movement time, postoperative fever, retroperitoneal drainage tube and catheter extubation time and postoperative hospitalization time were compared between patients with MS and non-MS under different operation methods. SPPS19.0 statistical software was used to compare the data between different groups, T-test analysis of measurement data, 2X test analysis of counting data, with P0.05 as the difference was statistically significant. Results: (1) the ratio of male to female in MS group was 25 / 29, the average age was 55.93 鹵10.34 years old, and there was no significant difference between male and female ratio of 132 / 31 in MS group compared with that in non-MS group (P0.05). The difference of preoperative preparation time between 5.47 鹵1.52d and 3.54 鹵1.27d was statistically significant by T test. However, chi-square test showed that MS had no significant effect on clinical staging. 2. Laparoscopic renal cell carcinoma patients, MS patients, operative time, intraoperative bleeding, postoperative intestinal function recovery time, The time of getting out of bed, postoperative fever, extubation time of retroperitoneal drainage tube, postoperative hospitalization time were different from those of non-MS patients, and the difference was statistically significant (P0.05), and there was no significant difference in the time of catheter pullout. The operative time, intraoperative bleeding, recovery time of intestinal function, time of getting out of bed, postoperative fever, extubation of retroperitoneal drainage tube, postoperative hospitalization time of MS patients were different compared with those of non-MS patients. And the difference was statistically significant (P0.05). There was no significant difference in the time of catheter pullout. 3. The percentage of patients with clear cell carcinoma with metabolic syndrome was the highest (67 / 93), papillary cell carcinoma (11 / 54). Chromophobe cell carcinoma (5 / 12), at the same time, all types of cell carcinoma accounted for no significant change in the overall percentage. The incidence of MS in patients with Furhman grade 鈪，

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