腹腔镜肾部分切除术和腹腔镜冷冻消融治疗肾皮质小肿块（< 3.5 cm）的疗效比较

Comparison of efficacy between laparoscopic partial nephrectomy and laparoscopic cryoablation in treatment of small renal cortical masses (< 3.5 cm)

摘要:

摘要：目的??比较腹腔镜肾部分切除术（LPN）和腹腔镜冷冻消融（LCA）治疗肾皮质小肿块（<3.5 cm）的围手术期情况和短期临床结局。方法?共纳入167例患者。其中，92例95处病灶接受LPN，75例患者91处病灶接受LCA。比较两组患者围手术期和临床结局。结果?LPN和LCA组肿块平均直径、术前、术后肌酐水平无差异（P =0.495，P =0.953，P =0.101）。LPN组平均年龄低于LCA组[（58.8±3.2）和（69.2±4.7）岁，P <0.01]，LPN组平均失血量更高[（168.4±17.2）和（66.1±8.3）ml，P =0.005]，平均手术时间更长[（151.6±13.2）和（128.6±10.8） min，P =0.001]。LCA组和LPN组中分别发生6种并发症。LPN和LCA组中位随访时间分别为（21.8±4.8）和（14.2±1.3）个月（P <0.01）。LCA组2例患者复发，LPN组1例患者复发。结论?在短期随访中，LPN和LCA治疗肾皮质小肿块的疗效无差异，LCA失血量较少、手术时间较短，且并发症发生率较低。

Abstract:

Abstract: Objective?To compare the laparoscopic partial nephrectomy (LPN) and Laparoscopic cryoablation (LCA) in treatment of small renal cortical tumors (﹤ 3.5 cm) perioperative and short-term clinical outcome.?Methods?167 patients were selected as research subjects, including 92 patients who received LPN in 95 lesions and 75 patients who received LCA in 91 lesions. The perioperative period and clinical outcomes of the two groups were compared.?Results?There was no difference in mean diameter, preoperative and postoperative creatinine levels between LPN and LCA groups (P = 0.495, P = 0.953, P = 0.101, respectively). The average age of patients in the LPN group was lower than that in the LCA group (58.8 ± 3.2) years vs (69.2 ± 4.7) years, P ﹤ 0.01), the average blood loss in the LPN group was higher (168.4 ± 17.2) vs (66.1 ± 8.3) ml, P = 0.005), and the average operation time in the LPN group was longer (151.6 ± 13.2) vs (128.6 ± 10.8) min, P = 0.001). Six complications occurred in LCA group and LPN group respectively. Median follow-up time in the LPN and LCA groups was (21.8 ± 4.8) months and (14.2 ± 1.3) months, respectively (P ﹤ 0.01). Relapse occurred in 2 patients in LCA group and 1 patient in LPN group.?Conclusion?There was no difference in the efficacy of LPN and LCA in treatment of small renal cortical masses in short-term follow-up, with less blood loss, shorter operation time and lower complication incidence of LCA.