半程肾动脉阻断在腹腔镜肾部分切除术中的应用  

Appliance value of half-course renal artery blocking in laparoscopy partial nephrectomy

作　　者：孙巍 刘建民[1] 郭园园[1] 杨小淮[1] 李立强 高五岳 刘贝贝[1] SUN Wei;LIU Jian-min;GUO Yuan-yuan;YANG Xiao-huai;LI Li-qiang;GAO Wu-yue;LIU Bei-bei(Department of Urology,The First Affiliated Hospital of Bengbu Medical College,Bengbu Anhui 233004,China)

机构地区：[1]蚌埠医学院第一附属医院泌尿外科,安徽蚌埠233004

出　　处：《蚌埠医学院学报》2020年第12期1611-1614,共4页Journal of Bengbu Medical College

基　　金：安徽省自然科学青年基金项目(1808085QH279);安徽省教育厅自然科学研究重点项目(KJ2019A0308);安徽省蚌埠市科技局创新指导项目[(2019)90]。

摘　　要：目的:探讨半程肾动脉阻断技术在腹腔镜肾部分切除术(laparoscopy partial nephrectomy,LPN)中的安全性及对残肾功能的保护作用。方法:回顾性分析行LPN的T1期肾脏肿瘤病人共94例。根据肾动脉阻断时程不同分为半程肾动脉阻断组(A组)32例和全程肾动脉阻断组(B组)62例。根据肿瘤分期不同,A组分为T1a期病人(A1组)21例和T1b期病人(A2)11例;B组分为T1a期病人(B1组)43例和T1b期病人(B2组)19例。分析病人手术时间、出血量、热缺血时间(warm ischemia time,WIT)、血尿、漏尿等围手术期指标和肾萎缩、肾功能下降等远期并发症等指标。结果:94例病人均手术顺利。A组病人WIT明显短于B组病人,eGFR下降值低于B组(P<0.01);病人WIT A1组短于B1组、A2组短于B2组(P<0.01)。但在手术时间、术中出血量、血尿、漏尿、肾萎缩等指标差异无统计学意义(P>0.05)。结论:半程肾动脉阻断技术可减少T1期肿瘤LPN中肾脏WIT,减少肾功能下降,尤其对T1b期肿瘤优势更为显著。该技术具有良好的安全性与实用性,值得临床推广。Objective:To investigate the safety and protective effect on renal function of half-course renal artery blocking in laparoscopy partial nephrectomy(LPN).Methods:The clinical data of 94 stage T1 renal cancer patients treated with LPN were retrospectively analyzed.The patients were divided into the half-course renal artery blocking group(group A,32 cases)and whole-course renal artery blocking group(group B,62 cases)according to the blocking course of renal artery.According to the tumor staging,the group A was subdivided into the stage T1 a group(group A1,21 cases)and stage T1 b group(group A2,11 cases),and the group B was subdivided into the stage T1 a group(group B1,43 cases)and stage T1 b group(group B2,19 cases).The operation time(OT),bleeding volume(BV),warm ischemia time(WIT),hematuria and urine leakage of perioperative indicators,and renal atrophy and renal function loss of long-term complications parameters in group A and group B were analyzed.Results:The operations in all patients were successfully completed.The WIT in group A was significant shorter that in group B,and the decreasing value of eGFR in group A was significant lower that in group B(P<0.01).The WIT in group A1 and group A2 were shorter those in group B1 and group B2,respectively(P<0.01).However,there was no statistical significance in OT,BV,hematuria,urine leakage,renal function decline and renal atrophy between group A and group B(P>0.05).Conclusions:The half-course renal artery blocking can shorten renal WIT and reduce incidence of postoperative renal atrophy,especially for patients with stage T1 b renal tumor.It has good safety and practicability,and is worthy of clinical application and promotion.

关 键 词：肾肿瘤 腹腔镜肾部分切除术 肾动脉半程阻断 热缺血时间 

分 类 号：R737.11[医药卫生—肿瘤]