后腹腔镜下原位低温肾脏部分切除术的临床研究  

Clinical research of retroperitoneal laparoscopic partial nephrectomy with hypothermic renal artery perfusion in situ

作　　者：方烈奎 杨江根 黄建生 张秩庠 黄向江 熊星 姜敏 肖克峰 

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》2014年第2期444-447,共4页Chinese Journal of Experimental Surgery

基　　金：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 探索安全有效、简单易行的后腹腔镜下肾脏低温保护技术.方法 拟行后腹腔镜下肾脏部分切除术患者22例,分为研究组和对照组.其中男12例,女10例,年龄为37～69岁,平均年龄52岁;4例为血管平滑肌脂肪瘤,18例为肾透明细胞癌.研究组在阻断患侧肾脏肾动脉后用冰盐水循环灌注系统使肾脏温度降至25℃以下后施行后腹腔镜下肾脏部分切除术;对照组同样在阻断肾动脉后施行患侧肾脏的后腹腔镜下肾脏部分切除术,但不采用肾脏低温技术.比较两组患者肾脏温度和直肠温度变化,以及两组手术前后总肾及患肾肾小球滤过率（GFR）变化.结果 22例患者手术顺利;术后无继发出血、感染及漏尿.研究组冷缺血时间（47.2±3.8） min,平均最低肾脏温度为（17.73±0.91）℃,肾脏温度达到25℃需（4.6±0.4） min;对照组热缺血时间（27.8±1.5） min,平均最低肾脏温度为（38.08±0.33）℃;研究组术前ECT示总肾GFR为（66.24±3.98） ml/min,患肾GFR为（30.57±4.07） ml/min;术后1个月总肾GFR为（53.89±7.53） ml/min,患肾GFR为（20.92±4.49） ml/min;术后3个月总肾GFR为（54.49±7.92） ml/min,患肾GFR为（21.63 ±5.21） ml/min;术后6个月总肾GFR为（54.77±7.84）ml/min,患肾GFR为（21.73±9.99） ml/min;对照组术前ECT示总肾GFR为（66.49±9.87） ml/min,息肾GFR为（30.65±5.45） ml/min;术后1个月总肾GFR为（54.89±9.61） ml/min,患肾GFR为（17.90±3.50） ml/min;术后3个月总肾GFR为（55.68±10.02） ml/min,患肾GFR为（18.09±3.39） ml/min;术后6个月总肾GFR为（55.82±5.12） mL/min,患肾GFR为（18.17±3.39） ml/min.术后随访1～16个月,未见局部复发、无转移.结论 本研究采用的后腹腔镜下肾脏低温保护技术简单易行、效果确切,易于临床推广.Objective To establish a new retroperitoneal laparoscopic technique which can keep the kidney in cold ischemia and has the characteristics of safety,effective and simplicity.Methods Twenty-two patients who needs to do the retroperitoneal laparoscopic partial nephrectomy were divided into two groups：the research group and the control group.There were 12 males and 10 females with average age of 37-69 years old.There were 4 cases of angiomyolipoma,and 18 cases of renal cell carcinoma.In research group,the renal temperature was reduced by circumfusion system of ice saline after clamping the renal artery,and then the retroperitoneal laparoscopic partial nephrectomy was done.In the control group,we did the same as well except the renal hypothermia.The renal temperature and the rectal temperature during the surgery,and the glomerular filtration rate （GFR） of both bilateral kidneys and the affected kidney before and after the surgery were compared.Results All the surgical operations were done successfully in both groups.No post-operative bleeding,inflammation and leakage of urine occurred.In the research group,the average cold ischemia time was （47.2 ±3.8） min,the average minimum renal temperature was （17.73 ± 0.91）,and the average time reducing the renal temperature to 25 ℃ was （4.6 ±0.4） min.In the control group,the average cold ischemia time was （27.8 ± 1.5） min,and the average minimum renal temperature was （38.08 ± 0.33）℃.In the research group,the average GFR of the bilateral kidneys and the affected kidneys was （66.24 ±3.98） and （30.57 ±4.07） ml/min one week before the surgery,that was 53.89 ±7.53 and （20.92 ±4.49） ml/min one month after the surgery,that was （54.49 ±7.92） and （21.63 ±5.21） ml/min 3 months after the surgery,and that was （54.77 ± 7.84） and （21.73 ± 9.99） ml/min 6 months after the surgery,respectively.In the control group,the average GFR of th bilateral kidneys and the affected kidney was 66.49 ±9.87 and （30.65 ±5.45） ml/min o

关 键 词：腹腔镜 肾脏部分切除术 冷缺血 

分 类 号：R699[医药卫生—泌尿科学]