目的:本研究旨在为保留肾单位手术(NSS)的不同手术方法的比较疗效提供有价值的见解,并为该领域的现有文献做出贡献。
方法:本研究包括2016年1月至2024年3月期间因肾脏小肿块而接受NSS的患者。共97例(开放入路组41例,腹腔镜入路组中56例),带有人口学,放射学,术中,肾功能,并纳入肿瘤随访数据.三种不同的解剖评分系统(R.E.N.A.L.肾脏评分,PADUA评分和C指数)用于评估肿瘤位置并估计与肺门和收集系统的接近度。
结果:在开放保留肾单位手术(ONSS)和腹腔镜保留肾单位手术(LNSS)组中,平均肾脏肿瘤直径(SD)分别为5.20±2.30和4.90±2.10,这在两个手术方法组中相似(p=0.061)。然而,用ONSS治疗的肿瘤具有明显更多的不良形态特征(p<0.05)。对于ONSS和LNSS组,平均R.E.N.A.L.肾脏测量评分(SD)分别为6.15±2.04和5.2±1.4(p=0.032),平均PADUA评分(SD)分别为7.46±1.14和6.8±1.0(p=0.049),C指数(SD)得分分别为1.39±0.4和1.37±0.5(p=0.062),分别。两组的平均肿瘤直径(cm)(分位数范围(IQR))分布均未发现显着差异(p=0.058)。尽管LNSS组的输血率略有增加,估计失血量(EBL),输血率,两组的住院时间相似.
结论:尽管LNSS在术中失血方面并不明显,住院时间和输血率,它提供了与ONSS相当的长期结果。我们的研究表明,当与肾病评分相匹配时,LNSS可以实现与ONSS类似的结果。
OBJECTIVE: This study aimed to provide valuable insights into the comparative efficacy of different surgical approaches for nephron-sparing surgery (NSS) and contribute to the existing literature in this field.
METHODS: This study included patients who underwent NSS for small renal masses between January 2016 and March 2024. A total of 97 patients (41 in the open approach group, 56 in the laparoscopic approach group) with demographic, radiological, intraoperative, renal functional, and oncological follow-up data were included. Three different anatomical scoring systems (R.E.N.A.L. nephrometry score, PADUA score and C-index) were utilised to assess tumour location and estimate proximity to the hilum and collecting system.
RESULTS: In the open nephron-sparing surgery (ONSS) and laparoscopic nephron-sparing surgery (LNSS) groups, the mean kidney tumour diameters (SD) were 5.20 ± 2.30 and 4.90 ± 2.10, which were similar in both surgical method groups (p = 0.061). However, tumours treated with ONSS had significantly more adverse morphometric features (p < 0.05). For ONSS and LNSS groups, the mean R.E.N.A.L. nephrometry scores (SD) were 6.15 ± 2.04 and 5.2 ± 1.4 (p = 0.032), respectively; The mean PADUA scores (SD) were 7.46 ± 1.14 and 6.8 ± 1.0 (p = 0.049), respectively; And the mean C-index (SD) scores were 1.39 ± 0.4 and 1.37 ± 0.5 (p = 0.062), respectively. No significant differences were found in the mean tumour diameter (cm) (Inter Quantile Range (IQR)) distribution of both groups (p = 0.058). Despite the slight increase in transfusion rate in the LNSS group, estimated blood loss (EBL), transfusion rates, and length of hospital stay were similar in both groups.
CONCLUSIONS: Although LNSS does not appear superior in terms of intraoperative blood loss, length of hospital stay and transfusion rate, it provides comparable long-term outcomes to ONSS. Our study suggests that when matched with nephrometry scores, LNSS can achieve similar outcomes to ONSS.