Clinical Analysis Of Nephrectomy With Partial Nephrectomy For T_1b Stage Renal Neoplasms

Objective:Inquiry for T1_b renal cancer patients Laparoscopic retains the nephron resection surgery,Laparoscopic nephron sparing surgery,LNSS)the clinical feasibility and curative effect.When the diameter of renal carcinoma was greater than4cm,the intraoperative kidney wound,operative time and intraoperative blood loss increased with the increase of tumor diameter,and the difficulty of surgery increased.However,partial nephrectomy with nephrosparing unit can not only remove the renal tumor,but also retain part of the normal renal parenchyma,which has a certain improvement on the effect of renal function and the quality of life of postoperative patients compared with radical nephrectomy.Therefore,renon-sparing surgery for renal cell carcinoma with diameter larger than 4cm is proved to be safe and effective,which can provide more surgical options for clinical practice.Methods:Collected in January 2010-January 2016 for renal tumors in the patients with the 1st affiliated hospital of Bengbu medical college,were retrospectively analyzed,including in 60 patients as the research object,the tumor diameter are in 4 to 7 cm?including 7.0 cm?,38 cases of men,women,22 cases,age distribution,at the age of 31-72 with an average age of 52±5.5,tumor were single and is located in the kidney,is located in the left side of the 37 cases,located on the right side of the 23 cases.The patients were divided into experimental group and control group according to different surgical methods.There were 20 males and 10females in the experimental group.The age distribution was 33-72 years old,with an average age of 54±6.4 years.The tumor diameter distribution was 4.2-7.0cm,with an average diameter of 5.4±1.2cm.Among them,the tumor was located at the left side in17 cases,the right side in 13 cases,the tumor was located at the upper pole in 21 cases,and the lower pole in 9 cases.In the control group,18 males and 12 females were aged31-70 years,with an average age of 52±7.5 years.The tumor diameter distribution was4.0-6.8cm,with an average diameter of 5.2±1.1cm.The tumor was located in the left side of 20 cases and the right side of 10 cases.The tumors were located in the upper pole in 22 cases and the lower pole in 8 cases.All the 30 patients in the experimental group received partial nephrectomy with peritoneoscope,while all the 30 patients in the control group received radical nephrectomy with peritoneoscope.Postoperative pathological staging was T1_bN₀M₀ in both groups.Comparison and analysis between the two groups of clinical parameters,including general data?age,sex,body mass index,tumor location,tumor diameter?,the average total time,in the average intraoperative blood loss,postoperative exhaust time for the first time,postoperative drainage tube extracting time,postoperative hospitalization days tumor recurrence rates,perioperative complications,and postoperative follow-up and postoperative survival rate and the corresponding indicators.Results:There was no significant difference in general data?age,gender,bmi,tumor location,tumor diameter?between the two groups?P>0.05?.The average total operation time,intraoperative blood loss,perioperative complication rate,postoperative drainage tube extraction time and postoperative hospitalization days in the experimental group were all greater than those in the control group?P<0.05?.However,there was no significant difference between the experimental group and the control group in postoperative first exhaust time,postoperative follow-up tumor recurrence rate and postoperative follow-up survival rate?P>0.05?.Conclusion:For 4-7 cm in diameter of renal tumor,with the increase of tumor diameter,the implementation of preserved renal resection of renal units of the average operation time,intraoperative blood loss,postoperative complications,postoperative drainage tube extracting time,postoperative hospitalization days kidney cancer radical prostatectomy were increased,but retains the nephron sparing surgery patients the time needed for recovery of intestinal function,postoperative follow-up of tumor recurrence rate and survival rate of postoperative follow-up compared with kidney cancer radical and no significant differences.Therefore,for renal cancer patients with single tumor located at the pole of the kidney with tumor diameter of 4-7cm and preoperative examination to evaluate the feasibility of partial nephrectomy,RPTR is a clinically feasible surgical method.