Abstract:

Objective　To compare the efficacies of 1 470 nm laser partial nephrectomy and nephron sparing surgery (NSS) in the treatment of renal clear cell carcinoma. Methods　The clinical data of 32 patients with renal clear cell carcinoma admitted to Dongguan Kanghua Hospital from April 2020 to December 2022 were retrospectively analyzed and were divided into a laser group (16 cases) and a NSS group (16 cases) according to different surgical methods. In the NSS group, 10 males and 6 females, aged (58.63±8.34) years, were treated with NSS. In the laser group, 9 males and 7 females, aged (58.06±9.18) years, were treated with 1 470 nm laser partial nephrectomy. The operation time, length of postoperative hospital stay, drainage tube removal time, intraoperative blood loss, creatinine changes before and after surgery, and neutrophil gelatinase-associated lipid carrier protein (NGAL) levels before and after surgery were compared between the two groups. Fisher exact probability method, independent sample t test, and Mann Whitney U test were used for statistical analysis. Results　There was no statistically significant difference in the operation time between the two groups (t=0.124, P>0.05). There were statistically significant differences in the length of postoperative hospital stay (Z=4.786, P<0.001), drainage tube removal time (Z=4.824, P<0.001), intraoperative blood loss (Z=4.768, P<0.001), and creatinine differences before and after surgery (1 week and 3 months) between the two groups (t=12.134 and 4.768, both P<0.001). There was no statistically significant difference in the preoperative NGAL level between the two groups (P>0.05). The NGAL levels in the laser group 2, 4, and 24 h after surgery were lower than those in the NSS group [(59.63±6.35) μg/L vs. (161.31±5.53) μg/L, (54.94±5.24) μg/L vs. (181.63±6.88) μg/L, (48.69±5.67) μg/L vs. (130.00±4.40) μg/L] (t=46.756, 56.782, and 43.898; all P<0.001). Conclusion　1 470 nm laser partial nephrectomy is feasible, and can effectively preserve the kidney function and shorten the hospital stay and extubation time.

Key words:

Clear cell carcinoma of kidney, Partial nephrectomy, 1 470 nm laser, Renal function

摘要：

目的　比较1 470 nm激光肾部分切除术与保留肾单位手术（NSS）治疗肾透明细胞癌的疗效。方法　回顾性分析2020年4月至2022年12月东莞康华医院收治的32例肾透明细胞癌患者的临床资料，根据手术方式的不同分为激光组和NSS组，每组16例。NSS组中男10例、女6例，年龄（58.63±8.34）岁，采用NSS治疗；激光组中男9例、女7例，年龄（58.06±9.18）岁，采用1 470 nm激光肾部分切除术。比较两组手术时间、术后住院时间、引流管拔除时间、术中出血量及手术前后肌酐变化、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）水平。采用Fisher确切概率法、独立样本t检验、Mann Whitney U检验。结果　两组患者手术时间比较差异无统计学意义（t=0.124、P>0.05）。两组患者的术后住院时间（Z=4.786，P<0.001）、引流管拔除时间（Z=4.824，P<0.001）、术中出血量（Z=4.768，P<0.001）、手术前后肌酐差值（1周、3个月）（t=12.134、4.768，均P<0.001）比较差异均有统计学意义。两组术前NGAL水平比较差异无统计学意义（P>0.05）。激光组NGAL水平术后2 h［（59.63±6.35）μg/L比（161.31±5.53）μg/L］、术后4 h［（54.94±5.24）μg/L比（181.63±6.87）μg/L］、术后24 h［（48.69±5.67）μg/L比（130.00±4.40）μg/L］均低于NSS组（t=46.756、56.782、43.898，均P<0.001）。结论　1 470 nm激光肾部分切除术切实可行，能有效保留患者肾脏功能，缩短住院天数及拔管时间。

关键词:

肾透明细胞癌, 肾部分切除术, 1 470 nm激光, 肾功能