后腹腔镜肾部分切除术中肾动脉分支阻断与主干阻断治疗肾肿瘤的疗效比较  

Efficacy of retroperitoneal laparoscopic partial nephrectomy with selective renal artery occlusion versus main renal artery occlusion

作　　者：李升 吴铁林[1] 许建挺[1] 殷民[1] 龙慧民[1] 周立斌 LI Sheng;WU Tielin;XU Jianting(Department of Urology,Ningbo Medical Center Lihuili Hospital,Ningbo 315000,China)

机构地区：[1]宁波市医疗中心李惠利医院泌尿外科,315000

出　　处：《浙江医学》2020年第7期709-712,I0005,共5页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技项目(2019KY603、2020KY858);宁波市自然基金项目(2017A610186、2019A610256)。

摘　　要：目的比较后腹腔镜肾部分切除术中肾动脉分支阻断与主干阻断治疗肾肿瘤的疗效。方法选取2017年1月至2019年1月在宁波市医疗中心李惠利医院行后腹腔镜下肾部分切除术的43例肾肿瘤患者为研究对象,术中采取肾动脉分支阻断[超选择(三级分支)或选择(二级分支)阻断,分支阻断组]20例,肾动脉主干阻断(主干阻断组)23例。比较两组患者手术一般情况、术中情况以及术后肾功能、并发症、住院时间、病理诊断及随访情况。结果所有患者均顺利完成手术,无术中转开放手术。与主干阻断组比较,分支阻断组手术时间延长,术中出血量增加,手术前后肾小球滤过率(eGFR)差值明显降低,差异均有统计学意义(均P<0.05);而两组患者阻断时间、术后并发症发生率及住院时间比较,差异均无统计学意义(均P>0.05)。两组患者术后病理诊断情况比较,差异无统计学意义(P>0.05);两组患者手术切缘均为阴性。术后随访3~33个月,CT或超声复查均无肿瘤复发或转移,均未发生肾积水、肾萎缩等。结论后腹腔镜肾部分切除术中肾动脉分支阻断,可避免大部分正常肾脏组织的热缺血及缺血再灌注损伤,且不增加术中及术后并发症,是后腹腔镜下肾部分切除术肾动脉主干阻断的有益补充,值得临床有选择性地推广。Objective To compare the efficacy of retroperitoneal laparoscopic partial nephrectomy by renal artery branch blockade and trunk blockade in the treatment of renal tumors.Methods Forty-three patients diagnosed with kidney cancer who underwent laparoscopic nephrectomy from January 2017 to January 2019 in the department of urology of Lihuili hospital of Ningbo medical center were analyzed.Twenty patients received renal artery branch occlusion[super-selection(third-level branch)or selective(second-level branch)occlusion,branch block group],and 23 patients received renal artery trunk occlusion(trunk block group).The general conditions,intraoperative conditions,postoperative renal function,complications,length of hospital stay,pathological diagnosis and follow-up results of the two groups were compared.Results The surgical procedure was smooth in both groups,and no cases were converted to open surgery.Compared with the trunk block group,the operation time was significantly prolonged,the introoperative blood loss was increased and eGFR was decreased in the branch occlusion group(P<0.05).However,there was no significant difference in the blocking time,postoperative complication rate and length of hospital stay between the two groups(P>0.05).The postoperative pathological diagnosis of the two groups of patients was not statistically significant(P>0.05).The surgical margins of both groups were negative.The follow-up period ranged from 3 to 33 months.No recurrence or metastasis was found by CT or ultrasound examinations in the two groups,and no complications such as hydronephrosis and renal atrophy were found after operation.Conclusion Retroperitoneal laparoscopic partial nephrectomy by renal artery branch blockade can avoid thermal ischemia and ischemia-reperfusion injury in most normal renal tissue without increasing intraoperative and postoperative complications.It is a useful supplement for the retroperitoneal laparoscopic partial nephrectomy by main renal arterial occlusion and it is worthy of clinical promotion.

关 键 词：肾肿瘤 腹腔镜肾部分切除术 分支阻断 

分 类 号：R737.11[医药卫生—肿瘤]