局限性肾癌患者腹腔镜肾部分切除术后长期预后的研究

Long term prognosis of patients with localized renal cell carcinoma undergoing laparoscopic partial nephrectomy

摘要:

目的 分析局限性肾癌患者腹腔镜肾部分切除术后影响长期预后的相关因素。方法 回顾性分析2020年1月－2021年1月该院110例因局限性肾癌行腹腔镜肾部分切除术治疗的患者的临床资料，依据患者术后3年内是否死亡，分为死亡组（n = 19）和存活组（n = 91），比较影响患者术后长期预后的相关因素。结果 与存活组相比，死亡组患者的高脂血症、糖尿病、高血压、肉瘤样分化、透明细胞型、T_1b至T_3a分期、美国麻醉医师协会（ASA）分级Ⅲ级至Ⅵ级占比均升高（P < 0.05），肿瘤最大径增大（P < 0.05），肾周脂肪梅奥粘连概率（MAP）评分和肾周脂肪密度升高（P < 0.05），手术时间、留置引流管时间延长（P < 0.05），尿素氮（BUN）、肌酐（Cr）、超敏C反应蛋白（Hs-CRP）、总胆固醇（TC）和微量白蛋白尿（MAU）水平升高（P < 0.05）。肉瘤样分化（OR＾ = 1.737，95％CI：1.074 ~ 2.807）、T分期为T_1b至T_3a（OR＾ = 1.627，95％CI：1.182 ~ 2.240）和Cr水平 ≥ 91.27 μmol/L（OR＾ = 1.923，95％CI：1.064 ~ 3.476）为影响局限性肾癌患者腹腔镜肾部分切除术后长期预后的危险因素（P < 0.05）。结论 局限性肾癌患者腹腔镜肾部分切除术后3年内死亡率较高，肉瘤样分化、T分期为T_1b至T_3a、Cr水平≥91.27 μmol/L与局限性肾癌患者腹腔镜肾部分切除术后长期预后情况有关，临床可对于该类患者采取干预措施。

Abstract:

Objective To analyze the related factors of long-term prognosis of patients with localized renal cell carcinoma after laparoscopic partial nephrectomy.Method Clinical data of 110 patients with localized renal cell carcinoma who underwent laparoscopic partial nephrectomy from January 2020 to January 2021 were retrospectively analyzed. According to whether the patients died within 3 years after operation, they were divided into death group (n = 19) and survival group (n = 91). The related factors of long-term prognosis of the two groups were compared.Results Compared with the survival group, the proportion of hyperlipidemia, diabetes, hypertension, sarcomatoid differentiation, clear cell type, T_1b ~ T_3a stage and American Society of Anesthesiologists (ASA) grade III ~ VI in the death group increased (P < 0.05), the maximum diameter of tumor increased (P < 0.05), score of Mayo adhesive probability (MAP) and perirenal fat density increased (P < 0.05), the operation time and indwelling drainage tube time prolonged (P < 0.05), and the levels of blood urea nitrogen (BUN), creatinine (Cr), hypersensitive C-reactive protein (Hs-CRP), total cholesterol (TC) and microalbuminuria (MAU) increased (P < 0.05). Sarcomatoid differentiation (OR＾ = 1.737, 95%CI: 1.074 ~ 2.807), T stage of T_1b~T_3a (OR＾ = 1.627, 95%CI: 1.182~2.240) and level of Cr ≥ 91.27 μmol/L (OR＾ = 1.923, 95%CI: 1.064~3.476) were risk factors for long-term prognosis of patients with localized renal cell carcinoma after laparoscopic partial nephrectomy (P < 0.05).Conclusion The mortality rate of patients with localized renal cell carcinoma within 3 years after laparoscopic partial nephrectomy is high. Sarcomatoid differentiation, T stage of T_1b ~ T_3a and level of Cr ≥ 91.27 μmol/L are related to the long-term prognosis of patients with localized renal cell carcinoma after laparoscopic partial nephrectomy. Clinical interventions could be taken for high-risk patients.