腹腔镜原位低温肾脏部分切除术的研究  

Experimental study on laparoscopic partial nephrectomy with renal hypothermia in situ

作　　者：黄建生 杨江根 方烈奎 张轶庠 熊星 姜敏 

机构地区：[1]暨南大学第二临床医学院（深圳市人民医院）泌尿外科,深圳518020

出　　处：《中华实验外科杂志》2011年第12期2086-2089,共4页Chinese Journal of Experimental Surgery

基　　金：基金项目：广东省社会发展领域科技计划资助项目（159）;深圳市科技计划资助项目（201002028）

摘　　要：目的探讨一种简单易行、效果确切的腹腔镜肾脏原位低温保护技术用于腹腔镜肾脏部分切除术。方法比格犬10条，分为实验组和对照组两组。实验组在阻断肾蒂血管后用一漏斗状装置通过腹腔镜Trocar向肾周置入碎冰块使肾脏温度下降，然后施行腹腔镜肾脏部分切除术，双侧肾脏均予同样的处理；对照组同样在阻断肾蒂血管后施行双侧的腹腔镜肾脏部分切除术，但不对肾脏进行低温处理，比较两组犬肾脏温度和直肠温度变化，以及两组实验前后肾功能[血尿素氮（BUN）及血肌酐（Cr）]变化。结果所有的实验动物均顺利完成双侧的腹腔镜肾脏部分切除术。实验组平均手术时间201min，平均出血量110ml，肾脏温度最低能达18．60℃，平均最低肾脏温度为19．71℃，肾脏温度达到25℃平均需时10．4min；对照组平均手术时间197min，平均出血量134ml，平均最低肾脏温度为35．12℃。实验组的肾脏温度与对照组对比明显降低，但直肠温度变化两组间差异无统计学意义。实验组实验前平均BUN3．95mmol／L，Cr57．48umol／L，实验后平均BUN6．24mmol／L，Cr80．30umol／L；对照组实验前平均BUN4．16mmol／L，Cr61．86umol／L，实验后平均BUN8．55mmol／L，Cr123．18umol／L，与对照组对比，实验组的肾功能指标在实验后升高幅度更小，肾功能受肾缺血损伤影响更小。结论腹腔镜肾脏原位低温方法简单易行、效果确切，可使肾脏温度降到比较理想的水平，能保护肾脏减轻肾缺血损伤，同时对体温无明显影响。Objective To detect one easy-to-use and efficient technique for laparoscopic renal in situ hypothermia protection during laparoscopic partial nephrectomy. Methods Ten beagles were divided into two groups, the experimental group and the control group. After clamping the renal vasculature, the renal hypothermia was induced by dropping ice slush around the kidney through a funnel-shaped device connecting to the trocar, and then laparoscopic partial nephreetomy was done in both kidneys of the experimental group. The same things were done in the control group except renal hypothermia. The change of renal temperature and rectal temperature during the experiment, and the difference of renal function （serum BUN and Cr） before and after the experiment were compared between the experimental group and the control group. Results Bilateral laparoscopic partial nephrectomies were done successfully in all the beagles of both groups. In the experimental group, the average operation time was 201 minutes, the average blood loss was 110 ml, the lowest point of renal temperature was 18.60 ℃, the average lowest renal temperature was 19. 71 ℃, and it took 10. 4 minutes on average to make the renal temperature reach 25 ℃. In the control group, the average operation time was 197 minutes, the average blood loss was 134 ml, and the average lowest renal temperature was 35.12 ℃. Compared with control group, the renal temperature was significantly decreased and the change of rectal temperature had little difference in the experimental group. In the experimental group the average value of BUN was 3.95 mmol/L and the average value of Cr was 57.48 umol/L before experimental, 6. 24 mmol/L and 80. 30 umol/L respectively after experiment. In the control group they were 4. 16 mmol/L and 61.86 umol/L before, and 8.55 mmol/L and 123.18 umol/L after experiment respectively. Compared with the control group, the increase of the values of BUN and Cr were significantly smaller after experiment, which meant the renal injury due to renal ischemi

关 键 词：腹腔镜 肾脏部分切除术 肾低温 

分 类 号：R737.11[医药卫生—肿瘤]