| Objective: To compare the clinical effect of 1aparoscopic parcial nephrectomy(LPN)and laparoscopic radical nephrectomy(laparoscopic radical nephrectomy)for T1 staged renal cell carcinoma in elderly patients.Methods: we selected a total of 68 patients with stage T1 limited renal cell carcinoma who were hospitalized in our hospital from January 2013 to January 2018 and agreed to be treated surgically.Among them,40 patients underwent laparoscopic partial nephrectomy and 28 patients underwent laparoscopic radical nephrectomy.Collected the data of sex,age,clinical symptoms,chronic diseases,tumor size and other relevant data.For patients in the LPN group,renal vascular resistance and the pathological report of the surgical margin should also be observed.All patients were followed for 2-60 months,and the total mortality and tumor-specific mortality in the two groups were studied by follow-up.By comparing these data,we evaluated the clinical effect of LPN and LRN in elderly patients with localized renal cell carcinoma in T1 stage.All the data were statistically analyzed by using SPSS19.0 software.The difference in P<0.05 was statistically significant.Results: All the 68 patients were operated smoothly.There was no open operation in group LPN and group LRN.One patient in the LPN group had severe complications of residual tumors and had an open nephrectomy at 2 weeks postoperatively.There were 40 cases in LPN group(including 31 males / 9 females),in LRN group(including 19 males / 9 females).The proportion of men and women in the two groups was divided into LPN group 77.5%/22.5% and LRN 67.9%/32.1%,and the two group had no statistical significance to P=0.375(P>0.05).The ages of LPN and LRN were 69.58±4.613 years old and 71.11±6.237 years old,respectively.There was no significant difference between two groups in P=0.252(P>0.05).There were 27 cases and 21 cases of LPN and LRN with chronic diseases respectively.There was no statistical difference in the calculated P<0.05.The tumor size in LPN group was 3.12±1.06 cm and LRN group was 4.44±1.20 cm,there was statistical difference P < 0.05.There was no significant difference between the two groups in the preoperative clinical symptoms and tumor location(left/right,upper/middle/lower)P>0.05.A total of 52 patients(76.5%)were found to have no clinical symptoms,2 cases of hematuria(2.9%),6 cases of backache(8.8%),2 cases of abdominal pain(2.9%),2 cases of frequent urination with urgency(2.9%),1 case of dysuria with chills(1.5%),1 case of backache with urinary difficulty(1.5%),1 case of backache with frequency urination(1.5%),1 case of syncope(1.5%).The average operative time of the two groups was 122.63±12.481 min in the LPN group and 141.11±24.327 min in the LRN group.There was a statistically significant difference between the two groups(P<0.05).The average vessel blockade time in the LPN group was 19.30±6.738 min,but not in the LRN group.In group LPN,the average bleeding amount was 122.00±273.25 ml,and the average bleeding amount in group LRN was 119.29±194.95 ml.There was there was no significant difference between the two groups(P=0.964)(P>0.05).In the LPN group,there were 2 intraoperative blood transfusions(one of which was infused with 2 units of leukocyte-suspended red blood cells + 150 ml of fresh frozen plasma,1 case of 10 units of concentrated red blood cells + 1000 ml of fresh frozen plasma),and LPN group had 1 postoperative blood transfusion;LRN group There were no blood transfusions in patients during and after surgery.There was no statistical difference in intraoperative blood transfusion and postoperative blood transfusion between the two groups(P>0.05 for both groups).The average drainage tube removal time in the two groups was 4.18±1.130 days in the LPN group and 3.29±1.049 days in the LRN group.There was a statistically significant difference between the two groups in P=0.002(P<0.05).The average postoperative feeding time in the two groups was 1.60±1.081 days in the LPN group and 1.21±0.630 days in the LRN group.There was no statistically significant difference between the two groups(P=0.069)(P>0.05).The average postoperative hospital stay in the two groups was 9.88±3.722 days in the LPN group and 8.29±1.997 days in the LRN group.There was a statistically significant P=0.044 between the two groups(P<0.05).In the two groups,the average preoperative SCr in group LPN was 73.38±17.080 umol/L,LRN group was 77.93±14.139 umol/L.There was no significant difference between the two groups P=0.251(P<0.05).Two groups of average three months after the operation of SCr in LPN group was 91.58±51.123 umol/L,group LRN,113.18±23.777 umol/L.The two groups had statistically significant difference compared with P=0.041(P<0.05).The total number of complications in the LPN group was 11(27.5%),and the total number of complications in the LRN group was 2(7.14%),which was statistically significant(P< 0.05).The postoperative follow-up time for both groups was 2~60 months(median follow-up duration was 31 months).One patient in the LPN group had local recurrence at 28 months and 41 months died of recurrence and metastasis.The death of cardiovascular disease occurred in 1 case due to other causes.There was no local recurrence or distant metastasis in the LRN group.There were 4 cases of cardiovascular disease death and 1 case died.After statistical analysis,P=0.73 tumors.Specific mortality P=1,by comparing the analysis of the total mortality and tumor-specific mortality were not statistically significant(P>0.05).Conclusion: LPN and LRN are safe and effective methods in the treatment of T1 stage renal carcinoma patients over 65 years old.Compared with LRN,LPN effectively preserves the renal unit to improve the postoperative renal function,making the renal dysfunction lighter than the LRN group,reducing the incidence of CKD.But the incidence of LPN is higher than that of LRN,and there may be a risk of residual tumor,so whether or not to do LPN depends on the size and location of the tumor,the patient's tolerance,and the experience of the doctor. |
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