后腹腔镜节段性肾动脉阻断保留肾单位手术对患肾功能的保护及生存结果分析  

Laparoscopic sparing-nephron partial nephrectomy with segmental renal artery clamping on protecting the affected renal function and analysis of its survival outcomes

作　　者：胡瑞洁[1] 陈方敏[2] 石家齐[2] 姜锡男[2] 钟思文[2] 唐帅[1] 陈绪龙[2] 刘畅翔 杨昊[3] 

机构地区：[1]贵州医科大学,贵阳550004 [2]贵州医科大学附属医院泌尿外科 [3]安顺市人民医院泌尿外科

出　　处：《临床泌尿外科杂志》2017年第5期344-347,352,共5页Journal of Clinical Urology

基　　金：贵州省国际科技合作项目(编号黔科合外G字[2011]7015);贵州省科学技术基金项目(编号黔科合字[2013]2029)

摘　　要：目的:对比后腹腔镜节段性肾动脉阻断保留肾单位手术(SRPN)与后腹腔镜肾动脉阻断保留肾单位手术(LPN)的临床结果,探讨SRPN对术后患肾功能的保护及生存结果。方法:回顾性分析贵州医科大学附属医院2008年4月~2012年3月治疗的47例局限性T1a期肾肿瘤患者的临床资料,其中19例患者行SRPN(A组),28例行LPN(B组)。随访5年,监测患肾GFR变化情况,收集并统计患者生存情况,并进行统计学分析。结果:随访5年,无一例患者出现转移及复发,A组1例患者术后第27个月发现输尿管结石,B组1例患者术后第23个月不慎摔伤导致肾挫伤,1例患者术后第38个月发现肾结石,1例患者于术后第47个月就诊发现肾功能急剧下降。两组5年总生存率均为100%,无病生存率分别为94.7%、89.3%(P>0.05)。术后3个月、6个月、12个月、24个月、60个月,两组患肾功能下降绝对值分别为(6.87±1.78)ml/min vs.(12.64±1.64)ml/min、(8.45±1.75)ml/min vs.(13.93±2.08)ml/min、(9.92±1.88)ml/min vs.(15.02±2.41)ml/min、(11.31±2.00)ml/min vs.(16.31±2.58)ml/min、(12.76±2.45)ml/min vs.(17.93±3.33)ml/min,差异均具有统计学意义(P<0.05)。结论:两组手术方式总生存率和无病生存率相同,说明手术方式的选择不影响患者存活期;术后患肾功能均有不同程度下降,且A组下降程度小于B组,提示SRPN手术可减缓术后肾功能下降,对术后肾功能具有保护作用,值得临床应用及推广。Objective： To compare the clinical outcomes between laparoscopic sparing-nephron partial nephrec tomy with segmental renal artery clamping （SRPN） and laparoscopic sparing-nephron partial nephrectomy （LPN）, and discuss the protection of SRPN on postoperative affected renal function and long-term survival outcomes. Method： A retrospective study of 47 patients in Affiliated Hospital of Guizhou Medical University between April 2008 and March 2012 who underwent partial nephrectomy for pT^a localized renal carcinoma. Actually, 19 cases received SRPN （Group A）, and 28 cases received LPN （Group B）. All the patients were followed up for five years, and the changes of GFR and the health conditions of the patients were recorded. Result： None had metasta- sis or recurrence. A case in group A found he had a ureteral stone in the 27th month after the surgery, in group B, a 65-year-old man had an accident of renal contusion in the 23rd month after the surgery,a case had a nephrolithia- sis in the 38th month after the surgery, a case had a rapid decrease in renal function in the 47th month after the surgery. The same overall survival of two groups were 100%, and the disease-free survival were 94.7% and 89.3% （P〉0.05）, respectively. Follow-up for 3 months, 6 months, 12 months, 24 months, 60 months, the ab- solute values of declining GFR were （6.87±1.78） ml/min vs. （12.64±1.64） ml/min （P〈0.05）, （8.45±1.75） ml/min vs. （13.93±2.08） ml/min （P〈0.05）, （9.92±1.88） ml/min vs. （15.02±2.41） ml/min （P〈0.05）,（11.31±2.00） ml/min vs. （16. 31±2. 58） ml/min （P〈0.05）, （12.76±2.45） ml/min vs. （17.93±3.33） ml/ min （P〈0.05）, respectively. There was significant difference in postoperative renal function. Conclusion： Two groups have the same overall survival and disease-free survival, indicating that the choice of surgical approach has no effect on survival. The postoperative affected renal function of two groups decrease in different degrees,

关 键 词：肾肿瘤 腹腔镜肾部分切除术 节段性肾动脉阻断 患肾功能 

分 类 号：R737.11[医药卫生—肿瘤]