机器人腹腔镜零缺血与肾动脉主干阻断肾部分切除术治疗T_(1a)期外生性肾脏肿瘤的临床研究  

Clinical effect between robot-assisted laparoscopic zero-ischemia and complete renal artery clamping partial nephrectomy on the treatment of exophytic T_(1a) renal tumor

作　　者：董毅 何屹 王辉 吴震杰 张宗勤 王坚超 徐红 刘冰 王林辉 DONG Yi;HE Yi;WANG Hui;WU Zhenjie;ZHANG Zongqin;WANG Jianchao;XU Hong;LIU Bing;WANG Linhui(Department of Urology,ChangZheng Hospital,Navy Military Medical University,Shanghai, 200003,China;Department of Urology,First Hospital of Jiaxing)

机构地区：[1]海军军医大学附属长征医院泌尿外科,上海200003 [2]嘉兴市第一医院泌尿外科

出　　处：《临床泌尿外科杂志》2019年第1期22-26,共5页Journal of Clinical Urology

基　　金：国家自然科学基金重点项目(编号81730073);第二军医大学精准医学转化应用研究专项(编号2017JZ22)

摘　　要：目的:对比机器人辅助腹腔镜零缺血与肾动脉主干阻断肾部分切除术治疗T_(1a)期外生性肾肿瘤的可行性、安全性与临床疗效。方法:回顾性分析2016年9月～2017年12月上海长征医院收治的99例使用零缺血或肾动脉主干阻断技术行机器人腹腔镜肾部分切除术患者的临床资料,其中21例采用零缺血技术(零缺血组),78例行肾动脉主干阻断(完全阻断组)。对两组患者资料进行倾向性匹配分析,按照1∶2最邻近匹配法,得到组间协变量均衡的样本,匹配后比较两组患者手术时间、术中出血量、热缺血时间、术后引流管留置时间、肾功能变化等指标。结果:匹配前,两组患者在肿瘤直径、R.E.N.A.L.评分等方面差异有统计学意义(P<0.05);匹配后,零缺血组有16例、完全阻断组有28例匹配成功,两组各基线指标比较差异均无统计学意义(P>0.05),两组在术中出血、手术时间、引流管留置时间、术后住院时间方面比较差异均无统计学意义(P>0.05)。零缺血技术避免了肾脏缺血,术后1个月肾功能保护效果较好,术后3个月肾功能无明显差异。结论:机器人辅助腹腔镜零缺血肾部分切除术这一新技术能安全、有效的应用于T_(1a)期外生性肾肿瘤的治疗,并不显著增加手术时间与术中失血,同时避免了肾实质热缺血再灌注损伤,术后短期肾功能保护较好。该技术的优势需要长期随访及大宗病例研究的验证,在应用过程中需要严格把握手术适应证。Objective:To compare the safety,feasibility and efficacy between robot-assisted laparoscopic zeroischemia and complete renal artery clamping partial nephrectomy for exophytic T1arenal tumor.Method:A total of99 patients with T1arenal tumor who received robot-assisted laparoscopic zero-ischemia and complete renal artery clamping partial nephrectomy in Shanghai ChangZheng Hospital between September 2016 and December 2017 were retrospectively collected.The group covariates were balanced through propensity score matching(PSM)using 1:2 nearest neighbor matching method.After PSM,comparisons between two groups have been made in warm ischemia time,operation time,blood loss,rate of blood transfusion,postoperative hospital stay,incidence of complications and postoperative follow-up status.Result:Among all patients,diameter of tumor and R.E.N.A.L.scores were significantly different between zero-ischemia and complete renal artery clamping group(P<0.05).After PSM,patient distributions were closely balanced.Regarding operating time,blood loss,postoperative drainage and hospital stay did not differ between zero-ischemia(n=16)and complete renal artery clamping group(n=28),while zero-ischemia had contributed to better 1-month renal function conservation.Conclusion:Zero-ischemia robot-assisted laparoscopic partial nephrectomy is a new method of protecting renal function and can be performed safely for exophytic T1arenal tumor.Patients in zero-ischemia group do not lose more blood or take more operational time than those in complete renal artery clamping group do,and postoperative short-term renal function injury caused by warm ischemia can be prevented.Further studies and a longer follow-up are warranted,but strict grasping the indications in the process of application is needed.

关 键 词：零缺血 机器人辅助腹腔镜 肾蒂阻断 肾部分切除术 肾肿瘤 

分 类 号：R737.11[医药卫生—肿瘤]