| ObjectiveSeparate analysis the laparoscopic nephron-sparing nephrectomy(NSS)and radical nephrectomy(RN)in patients with local renal tumors >4cm in diameter and laparoscopic nephron-sparing surgery(NSS)in renal tumors ?4cm in diameter and >4cm in diameter Patient data to explore the efficacy of laparoscopic preservation of nephron surgery for renal cancer with a diameter of >4cm.MethodsIn this study,we retrospectively analyzed the data of 201 patients with localized renal cell carcinoma who underwent laparoscopic surgery at the First Affiliated Hospital of Zhengzhou University from April 2012 to June 2016.The patients were divided into three groups according to their surgical methods and tumor stage.There were 35 cases of nephrectomy group(NSS)with tumor diameter greater than 4cm,and 120 cases of radical nephrectomy group(RN)and 46 cases of renal tissue group with tumor diameter less than 4cm.The nephrectomy group(NSS)and the radical nephrectomygroup(RN)with a tumor diameter greater than 4 cm were compared,and the nephron group(NSS)with a tumor diameter greater than 4 cm and the retention nephron group with a tumor diameter less than 4 cm.Comparison of preoperative clinical indicators(gender,age,tumor characteristics),perioperative factors(operating time,intraoperative blood loss,length of hospital stay,change in serum creatinine,etc.)and differences in postoperative complications between the two groups.Evaluate the efficacy of NSS surgery in patients with >4cm kidney cancer.ResultsThe surgical margins were negative in all 201 patients.In the first control group,there was no significant difference in age,gender,tumor diameter,site,and laterality between the two groups(P>0.05).The operation time of NSS group and RN group(108.5±30.1 and 115.6±42.6,P=0.362),intraoperative blood loss(30.7±15.7 and 38.0±31.9,P=0.197),postoperative indwelling drainage tube time(4.71±1.27 and 4.83±2.10,P=0.750),postoperative fasting time(2.17±0.86 and 2.27±0.75,P=0.525),postoperative hospital stay(8.74±2.32 and 9.15±2.84,P=0.262)Significance(P>0.05);1 patient in the RN group had major hemorrhage and was transferred to open,and 1 patient had lymphatic leakage after operation;the follow-up period was 3 to 30 months,with an average of 12 months.No recurrence or metastasis was seen in the follow-up patients..The difference in serum creatinine between the two groups(18.00±13.32 and 27.52±17.22,P<0.05)was statistically significant.In the second comparison group,the operative time,intraoperative blood loss,postoperative fasting time,postoperative hospital stay,intraoperative and postoperative complications,and surgery for patients with tumor diameters ?4cm and tumor diameter >4cm There were no statistically significant differences in outcomes such as transit open or radical treatment,and there was no statistical difference in the changes in serum creatinine between the two groups of patients before and after surger.ConclusionThe safety and efficacy of the NSS group in the treatment of >4cm localized renal tumors was the same as that of the RN group,and the RNN procedure was better able to retain the patient's nephrectomy and could be an excellent choice for patients with >4cm localized renal tumors.Compared with patients with ?4cm group,there was no significant difference in surgical risk and serum creatinine changes between >4cm NSS patients. |
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