摘要
目的 探讨代谢综合征(metabolic syndrome,MS)对肾透明细胞癌(clear cell renal cell carcinoma,ccRCC)的病理分级、分期及围手术期相关指标的影响.方法 选取2020年1月至2022年12月在苏州大学附属第一医院接受手术治疗的226例ccRCC患者的临床资料进行回顾性分析,根据是否合并MS分为MS组(n=67)与非MS组(n=159).比较两组患者的病理分级、分期以及围手术期相关指标,主要包括美国麻醉医师协会分级(American society of anesthesiologists,ASA)评分、术前准备时间、手术时间、肾动脉阻断时间、术中出血量、术中输血率,术后肠道功能恢复、拔出导尿管时间、拔出腹膜后引流管时间、术后发热情况、术后住院时间等.结果 高血压、糖尿病、高血脂与ccRCC病理分级、分期相关,差异均有统计学意义(P＜0.05).多因素logistic回归分析结果显示,高血压、糖尿病、高血脂是ccRCC分级的独立危险因素(P＜0.05),高血脂是ccRCC分期的独立危险因素(P＜0.05).在腹腔镜下肾部分切除术(laparoscopic partial nephrectomy,LPN)与腹腔镜下肾根治切除术(laparoscopic radial nephrectomy,LRN)围手术期,MS组术前准备、手术、拔出腹膜后引流管、术后住院时间均长于非MS组,ASA分级≥Ⅲ级比例与术后发热比例高于非MS组,术中出血量大于非MS组,差异均有统计学意义(P＜0.05).结论 MS与ccRCC病理分级、分期及围手术期相关指标均有相关性.因此,在ccRCC诊疗过程中,应重视MS,加强围手术期管理,帮助患者取得良好预后.
Abstract
Objective To study the effects of metabolic syndrome(MS)on pathological grading,staging and perioperative related indexes of clear cell renal carcinoma(ccRCC).Methods The case data of 226 patients with ccRCC who underwent surgical treatment in the First Affiliated Hospital of Soochow University from January 2020 to December 2022 were retrospectively analysed and divided into the MS group(n=67)and the non-MS group(n=159)according to whether they were combined with MS or not.Pathological grading and staging,as well as perioperative indicators,including American society of anesthesiologists(ASA)score,preoperative preparation time,operative time,renal artery block time,intraoperative bleeding,intraoperative blood transfusion rate,postoperative recovery of bowel function,time of removal of catheterisation,time of removal of retroperitoneal drain,postoperative fever,and postoperative hospital stay were compared between the two groups.Results Hypertension,diabetes mellitus,and hyperlipidemia were associated with ccRCC pathological grading and staging,and the differences were statistically significant(P＜0.05).Multifactorial logistic regression analysis suggested that hypertension,diabetes mellitus,and hyperlipidemia were independent risk factors for ccRCC grading(P＜0.05),and hyperlipidemia was an independent risk factor for ccRCC staging(P＜0.05).In the perioperative period of laparoscopic partial nephrectomy(LPN)and laparoscopic radical nephrectomy(LRN),the preoperative preparation time,operation time,retroperitoneal drain removal time,and postoperative hospital stay in the MS group were longer than those in the non-MS group,the proportion of ASA grade≥ Ⅲ and postoperative fever were higher than those in the non-MS group,and the intraoperative bleeding was more than that in the non-MS group,and all the differences were statistically significant(P＜0.05).Conclusions MS is correlated with ccRCC pathological grading,staging and perioperative related indexes.Therefore,attention should be paid to MS during ccRCC diagnosis and treatment,and perioperative management should be strengthened to help patients achieve a good prognosis.
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