肿瘤内侵程度对早期原发性肾癌患者围术期影响的研究

马德爽+何花+于生龙

[摘要] 目的 探讨肿瘤内侵程度在对早期原发性肾癌患者影响。方法 将本院收治的144例早期原发性肾癌患者为实验对象，以肿瘤边缘与肾盂、肾盏、血管或脂肪组织的距离为分组依据，<1cm的为实验组，并将≥1cm的为对照组；其中实验组有60例，对照组有84例，统计实验组与对照组的围手术期结果，并记录术后并发症并进行随访，对测定结果进行统计学处理和分析。结果 144例患者的性别、年龄、肿瘤大小、出血量、术后住院时间及并发症例数差异无统计学意义（P>0.05）。两组术中平均热缺血时间为22.4min，平均手术时间为123.7min。实验组患者术中的热缺血时间（P=0.000）、手术时间（P=0.000）均较对照组长，两组之间患者的热缺血时间和手术时间差异有统计学差异。所有患者随访12个月，均未见肿瘤复发或转移。结论 肿瘤边缘与肾盂、肾盏、血管或脂肪组织的距離反映肾部分切除术的复杂程度，并主要影响手术热缺血时间、手术时间。

[关键词]肿瘤内侵；早期原发性肾癌；围术期；手术时间

[中图分类号] R737.1 [文献标识码] A [文章编号] 2095-0616（2017）08-213-03

[Abstract] Objective To evaluate the effect of tumor invasive degree on patients with early primary renal cell carcinoma. Methods 144 patients with primary renal cell carcinoma who were admitted to our hospital were selected as research objects. According to the distance of the tumor margin to the renal pelvis， calyx， blood vessels or fat tissue， <1cm was selected as the experimental group and ≥1cm was selected as the control group. There are 60 cases in the experimental group and 84 cases in the control group. Perioperative outcomes of two groups were summarized， postoperative complications were recorded and followed up and measurement results were statistically processed and analyzed. Results Differences in Gender， age， tumor size， blood loss， postoperative hospitalization stay and the number of complications of 144 patients were had no statistical significance（P>0.05）. The mean warm ischemia time in operation was 22.4 min and the mean operative time was 123.7min. The mean warm ischemia time in operation and operative time of patients in the experimental group were（P=0.000） and（P=0.000） respectively， both longer than those of the control group. The mean warm ischemia time in operation and operative time of patients in two groups had statistical difference. All patients were followed for 12 months and it showed no tumor recurrence or metastasis. Conclusion The distance of the tumor margin to the renal pelvis， calyx， blood vessels or fat tissue reflects the complexity of partial nephrectomy and mainly affects the warm ischemia time in operation and the operative time.

[Key words] Tumor invasion； Early primary renal cell carcinoma ； Perioperative period； Operative time

研究显示肾细胞癌约占恶性肿瘤的2%～3%，在泌尿系统站第二的恶性肿瘤。中国肿瘤数据示，在1990～2001年之间天津市男女性，肾癌增长趋势逐年加大。美国肿瘤数据示近十年来肾癌发病率上升了126%，死亡率上升了36.5%，5年生存率仅提高了9%左右[1-3]。有30%左右肾癌患者在初次就诊时就有转移迹象，29%左右患者术后发生复发或转移，在全世界范围内每年死于肾癌者近10万例，对肾癌的研究依然是当今世界的热点 [4-5]。故对144例早期原发性肾癌进行回顾性分析，以探讨肿瘤与肾集合系统的相对位置关系对围手术期结果的影响。

1 资料与方法

1.1 一般资料

本院自2012年5月～2013年10月共收治144例早期原发性肾癌患者（都为单发癌），其中肿瘤边缘与肾盂、肾盏、血管或脂肪组织的距离为分组依据，其中距离<1cm的为实验组，并将距离≥1cm的为对照组。……