微创泌尿外科杂志

目的 探究Ⅰ期肾癌腹腔镜肾部分切除术（LPN）联合零缺血微波消融的临床效果及对肾功能、并发症、生存质量的影响。方法 回顾性分析2020年10月至2022年1月解放军联勤保障部队第九〇八医院泌尿外科95例临床分期Ⅰ期（pT1）肾癌患者的临床资料，根据手术方法的不同将其分为两组，其中47例采用传统LPN（阻断肾动脉）治疗者作为对照组，48例采用肾癌LPN联合零缺血微波消融治疗作为研究组。使用SPSS 25.0统计系统分析对比两组患者围术期情况、手术前后肾功能指标、炎症-应激因子、生存质量、功能状态及肾区疼痛程度，并比较两组术后并发症发生率、复发率。结果 研究组手术时间[（64.28±11.79）min]长于对照组[（57.61±10.83）min]，术后引流时间[（5.19±1.06）d]、住院时间[（11.28±2.47）d]短于对照组[分别为（6.54±1.37）d、（14.35±3.12）d]，差异均有统计学意义（P<0.05）；研究组术后3 d的C反应蛋白（CRP）、肿瘤坏死因子α(TNF-α)、丙二醛（MAD）、肾上腺素（epinephrine E）水平分别为（12.67±2.18）mg/L、（24.59±7.43）ng/L、（2.56±0.49）μmol/L、（40.79±7.05）μg/L，低于对照组的（15.30±2.79）mg/L、（30.42±8.16）ng/L、（3.12±0.57）μmol/L、（48.21±7.84）μg/L，差异均有统计学意义（P<0.05）；研究组术后3个月血肌酐（Cr）、尿素氮（BUN）水平分别为（95.13±17.65）μmol/L、（4.12±1.10）mmol/L，低于对照组的（112.39±20.18）μmol/L、（7.36±1.59）mmol/L，肾小球滤过率（eGFR）、肌酐清除率（Ccr）分别为（76.18±5.63）ml/min、（68.54±9.31）ml/min，高于对照组的（71.49±5.21）ml/min、（57.26±8.85）ml/min，差异均有统计学意义（P<0.05）；研究组术后3个月生活质量量表核心量表（EORTC QLQC30）评分、体力状况卡氏评分（KPS）分别为（78.53±7.11）分、（86.19±4.38）分，高于对照组的（73.46±7.68）分、（82.45±5.17）分，疼痛视觉模拟评分法（VAS）评分[（0.95±0.31）分]低于对照组[（1.46±0.43）分]，差异均有统计学意义（P<0.05）；研究组并发症总发生率为4.17%，低于对照组的19.15%，差异有统计学意义（P<0.05）。两组术后1年复发率比较差异无统计学意义（P>0.05）。结论 LPN联合零缺血微波消融治疗Ⅰ期肾癌可实现零缺血，减轻机体炎症-应激反应，减少术后并发症，对肾功能影响较小，有助于减轻肾区疼痛、改善机体功能状态及生存质量。

Methods A retrospective analysis was performed on the clinical data of 95 patients with clinically staged Ⅰ （pT1） renal cell carcinoma admitted to the Department of Urology, the 908 th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, from October 2020 to January 2022. According to the surgical method, patients were divided into two groups: 47 patients who received traditional LPN(with renal artery clamping) were assigned to the control group, and 48 patients who underwent LPN combined with zero-ischemia microwave ablation for renal cell carcinoma were assigned to the study group. The SPSS 25.0 statistical system was used to analyze and compare perioperative conditions, renal function indicators before and after surgery, inflammatory-stress factors, quality of life, functional status, and renal region pain intensity between the two groups. The incidence of postoperative complications and recurrence rate were also compared between the two groups. Results Independent samples t-test showed that the operation time of the study group [(64.28±11.79)minutes] was longer than that of the control group [(57.61±10.83)minutes], while the postoperative drainage time [(5.19±1.06)days] and hospital stay [(11.28±2.47)days] were shorter than those of the control group [(6.54±1.37)days and(14.35±3.12)days, respectively], with statistically significant differences(all P<0.05). On the 3 rd day after surgery, the levels of C-reactive protein(CRP), tumor necrosis factor-α(TNF-α), malondialdehyde(MDA), and epinephrine(E) in the study group were(12.67±2.18)mg/L,(24.59±7.43)ng/L,(2.56±0.49)μmol/L, and(40.79±7.05)μg/L, respectively, which were lower than those in the control group [(15.30±2.79)mg/L,(30.42±8.16)ng/L,(3.12±0.57)μmol/L, and(48.21±7.84)μg/L, respectively], with statistically significant differences(all P<0.05). At 3 months after surgery, the levels of serum creatinine(Cr) and blood urea nitrogen(BUN) in the study group were(95.13±17.65)μmol/L and(4.12±1.10)mmol/L, respectively, lower than those in the control group [(112.39±20.18)μmol/L and(7.36±1.59)mmol/L, respectively]; the estimated glomerular filtration rate(eGFR) and creatinine clearance rate(Ccr) in the study group were(76.18±5.63)mL/min and(68.54±9.31)m L/min, respectively, higher than those in the control group [(71.49±5.21)mL/min and(57.26±8.85)mL/min, respectively], with statistically significant differences(all P<0.05). At 3 months after surgery, the scores of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30(EORTC QLQ-C30) and Karnofsky Performance Status(KPS) in the study group were(78.53±7.11) and(86.19±4.38), respectively, higher than those in the control group [(73.46±7.68) and(82.45±5.17), respectively]; the Visual Analogue Scale(VAS) score for pain in the study group [(0.95±0.31)] was lower than that in the control group [(1.46±0.43)], with statistically significant differences(all P<0.05). Chi-square test showed that the total incidence of complications in the study group was 4.17%, which was lower than 19.15% in the control group, with a statistically significant difference(P<0.05). There was no statistically significant difference in the 1-year postoperative recurrence rate between the two groups(P>0.05). Conclusion LPN combined with zero-ischemia microwave ablation for Stage Ⅰ renal cell carcinoma can achieve zero ischemia, reduce the body's inflammatory-stress response, decrease postoperative complications, have less impact on renal function, and help alleviate renal region pain, improve the body's functional status and quality of life. Objective To explore the clinical efficacy of laparoscopic partial nephrectomy(LPN) combined with zero-ischemia microwave ablation for Stage Ⅰ renal cell carcinoma, and its effects on renal function, complications, and quality of life.