肾段动脉阻断与全阻断在后腹腔镜肾部分切除中的比较分析  

Segmental artery clamping versus main renal artery clamping for renal mass

作　　者：高跃[1] 李刚[1] 李星[1] 彭博[1] 牛远杰[1] 

机构地区：[1]天津医科大学第二医院泌尿外科天津市泌尿外科研究所,300211

出　　处：《现代泌尿生殖肿瘤杂志》2014年第2期73-76,共4页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的比较肾段动脉阻断和肾动脉全阻断下行后腹腔镜肾部分切除术对于治疗肾癌的有效性及安全性。方法收集2010年6月至2013年5月接受腹腔镜下保留肾单位手术的59例患者的完整临床资料,其中肾段动脉阻断21例,全阻断38例,肿瘤直径均≤5cm。比较两组患者肾动脉阻断时间、术中出血量、术后并发症、住院天数以及术后3d内肌酐变化百分比（评估肾功能变化）等。结果两组肾动脉阻断时间差异有统计学意义（P〈0.05）;术后住院时间、术中出血量差异无统计学意义（P＞0.05）;术后3d内两组肌酐变化百分比差异有统计学意义（P=0.03）,说明超选比全阻断对肾功能的影响小。术后并发症发生率分别为4.8%（1/21）及5.3%（2/38）。术后随访3～12个月,无1例复发。结论对于小肾癌,超选择性肾段动脉阻断并未增加出血的风险及手术时间,却明显减少全阻断热缺血对肾功能的损害。Objective To compare the efficacy and safety on renal carcinoma with segmental artery clamping and main renal artery clamping in retroperitoneal laparoscopic partial nephrectomy（RLPN）. Methods A retrospective analysis of a consecutive series of 59 patients who underwent RLPN（including segmental artery clamping and main renal artery clamping）from June 2010 to May 2013.The tumor diam-eter was within 7 cm.Thirty-eight patients underwent surgeries with main renal artery clamping,and twenty-one underwent surgeries with segmental artery clamping.Chief complaint,blood loss,warm is-chemia （WI）time,the rate of change about creatinine and complications affected renal function be-fore and after operation were recorded. Results All RLPNs were completed without conversion to open surgery or nephrectomy.The novel technique slightly increased WI time（P〈0.05）.Intraop-erative blood loss and the length of stay after the operation have no significant difference between the two methosd （P〉0.05）.We can get the information through the rate of change about creatinine that It provided better postoperative renal function （P=0.033）compared with the conventional tech-nique when using segmental artery clamping.The complication rate was 5 .5% in the patients who undergo the segmental artery clamping.If the patients undergo the main renal artery clamping,the number is 5 .2%.Tumor size and location influenced the number of clamped segmental arteries. Long-term postoperative renal function is still awaited. Conclusions LPN with segmental artery clamping is safe and feasible in clinical practice.It minimizes the intraoperative WI inj ury and reduces the early postoperative damage of renal function compared with main renal artery clamping.

关 键 词：腹腔镜 肾部分切除 肾段动脉 

分 类 号：R737.11[医药卫生—肿瘤]