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腹腔镜射频消融术与部分肾切除术治疗cT1a期肾肿瘤:179例患者的长期随访结果

Laparoscopic Radiofrequency Ablation versus Partial Nephrectomy for cT1a Renal Tumors: Long-Term Outcome of 179 Patients.

作者信息

Ji Changwei, Zhao Xiaozhi, Zhang Shiwei, Liu Guangxiang, Li Xiaogong, Zhang Gutian, Minervini Andrea, Guo Hongqian

机构信息

Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.

出版信息

Urol Int. 2016;96(3):345-53. doi: 10.1159/000443672. Epub 2016 Jan 19.

Abstract

OBJECTIVES

To compare the long-term functional and oncological results between laparoscopic radiofrequency ablation (LRFA) and laparoscopic partial nephrectomy (LPN) in selected clinical T1a (cT1a) renal tumor patients.

METHODS

We retrospectively analyzed the medical records of patients with cT1a renal tumors who had LRFA or LPN at our institution between February 2006 and February 2015. Student's t test was used to compare the perioperative data between the two groups. Survival analyses were calculated using the Kaplan-Meier method.

RESULTS

A total of 179 patients were included in the study. Patients in the LRFA cohort were significantly older and had higher American Society of Anesthesiologists sore than in the LPN cohort. The LRFA group had a significantly lower mean blood loss than the LPN group (p = 0.03). The percent decrease of GFR in the LRFA group was significantly lower than in the LPN group (p = 0.021). The 5-year overall, cancer-specific and disease-free survival were 93.3 vs. 94.6%, 98.0 vs. 98.5% and 97.1 vs. 97.3%, for LRFA and LPN, respectively (all p value >0.05).

CONCLUSIONS

The excellent perioperative results, long-term functional and oncological outcomes of LRFA confirm that this technique is safe, nephron sparing and oncologically effective for the treatment of cT1a renal tumors.

摘要

目的

比较腹腔镜射频消融术(LRFA)与腹腔镜部分肾切除术(LPN)在特定临床T1a(cT1a)肾肿瘤患者中的长期功能和肿瘤学结果。

方法

我们回顾性分析了2006年2月至2015年2月期间在本机构接受LRFA或LPN治疗的cT1a肾肿瘤患者的病历。采用学生t检验比较两组的围手术期数据。使用Kaplan-Meier方法进行生存分析。

结果

本研究共纳入179例患者。LRFA队列中的患者比LPN队列中的患者年龄显著更大,美国麻醉医师协会评分更高。LRFA组的平均失血量显著低于LPN组(p = 0.03)。LRFA组的肾小球滤过率下降百分比显著低于LPN组(p = 0.021)。LRFA和LPN的5年总生存率、癌症特异性生存率和无病生存率分别为93.3%对94.6%、98.0%对98.5%和97.1%对97.3%(所有p值>0.05)。

结论

LRFA出色的围手术期结果、长期功能和肿瘤学结果证实,该技术对于治疗cT1a肾肿瘤是安全的、保留肾单位的且在肿瘤学上是有效的。

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