| 汪 洋,徐新宇,秦 聪,邵景龙,冯宁翰.后腹腔镜肾部分切除术治疗局限性肾癌的临床疗效及预后的影响因素分析[J].,2023,(5):985-990 |
| 后腹腔镜肾部分切除术治疗局限性肾癌的临床疗效及预后的影响因素分析 |
| Retroperitoneal Laparoscopic Partial Nephrectomy for Localized Renal Cell Carcinoma: Clinical Efficacy and Prognostic Factors |
| 投稿时间：2022-05-26 修订日期：2022-06-21 |
| DOI：10.13241/j.cnki.pmb.2023.05.037 |
| 中文关键词: 局限性肾癌 后腹腔镜 肾部分切除术 疗效 预后 影响因素 |
| 英文关键词: Localized renal cell carcinoma Retroperitoneal laparoscopy Partial nephrectomy Efficacy Prognosis Influence factor |
| 基金项目:国家自然科学基金面上项目（81272831） |
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| 中文摘要: |
| 摘要 目的：探究后腹腔镜肾部分切除术治疗局限性肾癌的临床疗效及预后的影响因素。方法：选取2015年6月~2017年6月于江南大学附属中心医院接受诊治的92例局限性肾癌患者作为研究对象，所有患者均行后腹腔镜肾部分切除术治疗。收集患者的临床资料；观察患者围术期相关指标、肾功能变化和并发症发生情况。随访5年，采用Kaplan-Meier法对局限性肾癌患者行预后分析；采用多因素COX比例风险回归分析局限性肾癌患者预后的影响因素，并建立关于预后评估的Log（P/1-P）回归预测模型。结果：患者手术前后肾功能变化不明显（P＞0.05）；经后腹腔镜肾部分切除术治疗后，并发症总发生率为5.43%（5/92）；Kaplan-Meier生存曲线显示局限性肾癌患者的5年累积生存率为66.28％（57/86），根据患者5年预后情况将其分为死亡组（n=29），存活组（n=57）；单因素分析显示，死亡组Fuhrma分级为中低分化、存在区域淋巴结转移、侵及集合系统和侵及深静脉占比高于存活组（P＜0.05）.COX回归模型分析结果显示Fuhrma分级为中低分化、存在区域淋巴结转移和侵及集合系统是影响局限性肾癌患者预后的危险因素（P＜0.05）。Log（P/1-P）回归预测模型有较高的预测效能，AUC（0.95CI）为0.877（0.818～0.929）。结论：对局限性肾癌患者应用后腹腔镜肾部分切除术治疗，临床疗效较好，其肾功能受到影响较小且并发症发病率较低；局限性肾癌患者预后的危险因素包括Fuhrma分级为中低分化、存在区域淋巴结转移和侵及集合系统，并对预后有较高的评估价值。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the clinical efficacy and prognostic factors of retroperitoneal laparoscopic partial nephrectomy for localized renal cell carcinoma. Methods: 92 patients with localized renal cancer who were diagnosed and treated in Affiliated Central Hospital of Jiangnan University from June 2015 to June 2017 were selected as the study subjects. All patients underwent retroperitoneal laparoscopic partial nephrectomy. Collect clinical data of patients. Perioperative related indexes, changes of renal function and complications were observed. Follow up for 5 years, Kaplan Meier method was used to analyze the prognosis of patients with localized renal cell carcinoma. Multivariate COX proportional hazard regression was used to analyze the factors affecting the prognosis of patients with localized renal cell carcinoma, and a Log (P/1-P) regression prediction model for prognosis evaluation was established. Results: There was no significant change in renal function before and after operation (P>0.05). After retroperitoneal laparoscopic partial nephrectomy, the total incidence of complications was 5.43% (5/92); Kaplan Meier survival curve showed that the 5-year cumulative survival rate of patients with localized renal cell carcinoma was 66.28% (57/86). The patients were divided into death group (n=29) and survival group(n=57) according to their 5-year prognostic. Univariate analysis showed that the proportion of Fuhrma in death group with moderate and low differentiation, regional lymph node metastasis, aggregation system invasion and deep vein invasion was higher than that in survival group (P<0.05). The results of COX regression model analysis showed that Fuhrma with moderate and low differentiation, regional lymph node metastasis and aggregation system invasion were risk factors affecting the prognosis of patients with localized renal cell carcinoma (P<0.05). Log (P/1-P) regression prediction model has higher prediction efficiency, AUC (0.95CI) was 0.877 (0.818～0.929). Conclusion: Retroperitoneal laparoscopic partial nephrectomy has a good clinical effect on patients with localized renal cell carcinoma. The renal function is less affected and the incidence rate of complications is lower; The risk factors for the prognosis of patients with localized renal cell carcinoma include Fuhrma grade of moderate to low differentiation, regional lymph node metastasis and invasion of the collecting system, which are of high prognostic value. |
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