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作 者:綦德柱 袁效良 任禹霏 孙立江[2] 骆磊[2] 张桂铭[2] QI Dezhu;YUAN Xiaoliang;REN Yufei;SUN Lijiang;LUO Lei;ZHANG Guiming(Department of Urology, Jiaozhou Central Hospital of Qingdao, Jiaozhou 266300, Chin)
机构地区:[1]青岛市胶州市中心医院泌尿外科,山东胶州266300 [2]青岛大学附属医院泌尿外科
出 处:《齐鲁医学杂志》2017年第5期505-507,511,共4页Medical Journal of Qilu
基 金:国家自然科学基金项目(NSFC 81502195);山东省医药卫生科技发展计划项目(2016WS0258)
摘 要:目的探讨RENAL评分≥7分肾肿瘤病人行后腹腔镜下肾动脉分支选择性阻断肾部分切除术的疗效。方法 2013年6月—2015年12月,在青岛大学附属医院和胶州市中心医院住院的RENAL评分≥7分的肾肿瘤病人63例,分别采用选择性肾动脉分支阻断及标准肾部分切除术进行治疗,比较两组手术时间、热缺血时间、切缘阳性率、输血率、术中出血量、术后并发症及住院时间,并比较两组术后不同时间肾功能。结果标准肾部分切除组手术时间较选择性肾动脉分支阻断组短,差异有统计学意义(t=4.859,P<0.05)。两组热缺血时间、切缘阳性率、输血率、术中出血量、术后并发症发生率及住院时间比较差异均无统计学意义(P>0.05)。术后1个月时选择性肾动脉分支阻断组患肾肾小球滤过率(eGFR)下降程度明显低于标准肾部分切除组,差异有统计学意义(t=2.687,P<0.05);术后12个月时两组患肾eGFR差异无统计学意义(P>0.05)。结论对RENAL评分≥7分肾肿瘤病人行后腹腔镜下肾动脉分支选择性阻断肾部分切除术可在术后早期最大限度地保护患肾功能,且不会增加术中出血量及术后并发症等,是一种安全有效的手术方法,值得临床推广。Objective To investigate the clinical effect of retroperitoneal laparoscopic partial nephrectomy with selective renal artery branch clamping in the treatment of renal tumor patients with a RENAL score of≥7.Methods A total of 63 renal tumor patients with a RENAL score of≥7 who were hospitalized in The Affiliated Hospital of Qingdao University and Jiaozhou Central Hospital from June 2013 to December 2015 were enrolled and treated with selective renal artery branch clamping or standard partial nephrectomy.The two groups were compared in terms of time of operation,warm ischemia time,rate of positive resection margin,blood transfusion rate,intraoperative blood loss,postoperative complications,and length of hospital stay,as well as renal function at different time points.Results The standard partial nephrectomy group had a significantly shorter time of operation than the selective renal artery branch clamping group(t=4.859,P〈0.05).There were no significant differences between the two groups in warm ischemia time,rate of positive resection margin,blood transfusion rate,intraoperative blood loss,incidence rates of postoperative complications,and length of hospital stay(P〈0.05).At one month after surgery,the selective renal artery branch clamping group had a significantly greater reduction in estimated glomerular filtration rate(eGFR)compared with the standard partial nephrectomy group(t=2.687,P〈0.05);at 12 months after surgery,there was no significant difference in eGFR between the two groups(P〈0.05).Conclusion In renal tumor patients with a RENAL score of≥7,retroperitoneal laparoscopic partial nephrectomy with selective renal artery branch clamping can protect their renal function in the early stage after surgery and does not increase intraoperative blood loss and postoperative complications.It is a safe and effective surgical method and thus holds promise for clinical application.
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