大体积肾癌腹腔镜根治性肾切除术前栓塞的临床应用及创伤应激评价  

Clinical application and traumatic stress evaluation of preoperative embolization prior to laparoscopic radical nephrectomy for massive renal cell carcinoma

作　　者：吴少杰[1,2] 方主亭[1,2] 林婷婷 陈平舟 蔡森林[1,2] 唐仪[1,2] 周艳峰[1,2] WU Shao-jie;FANG Zhu-ting;LIN Ting-ting;CHEN Ping-zhou;CAI Sen-lin;TANG Yi;ZHOU Yan-feng(Shengli Clinical Medical College,Fujian Medical University,Fuzhou 350001,China;Department of Interventional Radiology,Fujian Provincial Hospital,Fuzhou 350001,China;Department of Urology,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院,福州350001 [2]福建省立医院介入放射科,福州350001 [3]福建省立医院泌尿外科,福州350001

出　　处：《创伤与急诊电子杂志》2019年第4期181-186,共6页Journal of Trauma and Emergency(Electronic Version)

基　　金：福建省卫健委中青年骨干人才培养项目资金资助(编号2017-ZQN-1)。

摘　　要：目的探讨术前动脉栓塞在大体积肾癌腹腔镜根治性肾切除术(laparoscopic radical nephrectomy,LRN)的临床应用及创伤应激情况。方法回顾性分析2015年2月至2018年8月福建省立医院收治的92例大体积肾癌患者临床资料,LRN前对肿瘤血管行经导管动脉栓塞术(transcatheter arterial embolization,TAE)患者38例为介入组,同期术前未行TAE患者54例为对照组,比较两组患者临床疗效指标及应激因子变化。结果两组患者在手术创伤、术后恢复差异有统计学意义(P<0.05);两组术后24h外周血白细胞(white blood cell,WBC)计数、C反应蛋白(C-reactive protein,CRP)及白介素-6(interleukin-6,IL-6)较术前均升高,且对照组高于介入组,差异有统计学意义(P<0.05);介入组ClavienⅡ级及以上并发症低于对照组(5.3%比11.1%),但差异无统计学意义(P>0.05)。结论对于大体积肾癌LRN术前TAE能有效减少外科手术中出血、缩短手术时间,减轻手术创伤应激,有利于患者术后早期恢复,是一项有临床实用价值的微创技术。Objective To evaluate the effectiveness and traumatic stress of preoperative arterial embolization prior to laparoscopic radical nephrectomy(LRN)for massive renal carcinoma.Methods Ninety-two cases of massive renal carcinoma between February 2015 and August 2018 were retrospectively reviewed.Among which,38 cases of massive renal carcinoma undergoing transcatheter arterial embolization(TAE)before LRN were allocated to intervention group and 54 cases of massive renal carcinoma removed surgically without TAE were allocated to control group.The surgical trauma,postoperative recovery,postoperative complications and traumatic stress factors were compared between the two groups.Results There were significant differences about the surgical trauma and postoperative recovery between the two groups(P<0.05).The level of WBC,CRP and IL-6 in peripheral blood 24 hours after operation in the two groups were higher than those before operation,and the indices in the control group were higher than those in the intervention group(P<0.05).The Clavien-Dindo Classification was applied to both groups.The rate of gradeⅡand above complications in the intervention group was lower than that in the control group(5.3%vs 11.1%)without significant difference(P>0.05).Conclusion TAE prior to LRN for massive renal carcinoma could effectively decrease blood loss during the surgery,shorten the operation time,alleviate traumatic stress,and conduce to the early postoperative recovery of patients.It is a minimally invasive technology full of pragmatic value in clinical practice.

关 键 词：大体积肾癌 栓塞 手术 创伤 

分 类 号：R737.11[医药卫生—肿瘤] R749.4[医药卫生—临床医学]