分期≥T1b期肾癌患者行后腹腔镜下选择性肾动脉分支阻断保留肾单位手术的效果分析  

Efficacy analysis of retroperitoneal laparoscopic selective renal artery branch occlusion and nephron sparing surgery for≥T1b stage renal carcinoma

作　　者：廖新惠[1] 安君 苏港林 李雁锋 董颖 殷涛 吴诚龙 王翰[1] 韩晓红[1] 梅红兵[1] Liao Xinhui;An Jun;Su Ganglin;Li Yanfeng;Dong Ying;Yin Tao;Wu Chenglong;Wang Han;Han Xiaohong;Mei Hongbing(Department of Urology,the Second People′s Hospital of Shenzhen,the First Affiliated Hospital of Shenzhen University,Shenzhen 518035,China;Guangdong Key Laboratory of Systems Biology and Synthetic Biology for Urogenital Tumors,Shenzhen 518035,China;Shenzhen Key Laboratory of Genitourinary Tumor,Shenzhen 518035,China)

机构地区：[1]深圳市第二人民医院深圳大学第一附属医院泌尿外科,深圳518035 [2]广东省泌尿生殖肿瘤系统与合成生物学重点实验室,深圳518035 [3]深圳市泌尿生殖系统肿瘤研究重点实验室,深圳518035

出　　处：《中华医学杂志》2021年第48期3961-3965,共5页National Medical Journal of China

基　　金：深圳市“医疗卫生三名工程”项目(SZSM202111007);深圳市医学重点学科建设经费(SZXK020)。

摘　　要：目的探讨≥T1b期肾癌患者实施后腹腔镜下选择性肾动脉分支阻断保留肾单位手术的安全性和有效性。方法2016年7月至2020年9月,在深圳大学第一附属医院进行后腹腔镜下保留肾单位手术治疗的≥T1b期的肾癌患者35例,分别采用后腹腔镜下肾动脉全阻断(A组)和选择性肾动脉分支阻断(B组)保留肾单位手术,比较两组手术时间、热缺血时间、输血率、切缘阳性率、术中出血量、术后并发症及住院时间,并比较两组患者术前、术后3个月、术后12个月的总肾小球滤过率(GFR)和患肾单侧GFR(sGFR)。结果35例患者中,男19例、女16例;年龄(55.7±8.4)岁;体质指数(24.6±3.1)kg/m2;肿瘤直径(54.7±10.3)mm。A组手术时间短于B组[(103.5±14.3)比(123.2±14.1)min,P=0.003]。两组热缺血时间、输血率、切缘阳性率、术中出血量、术后并发症发生率及住院时间差异均无统计学意义(均P>0.05)。A组术后3个月、术后12个月患肾sGFR较术前下降程度均高于B组[(23.1±3.6)比(29.1±7.1)ml/min;(25.9±4.7)比(30.7±7.2),均P<0.05]。结论分期≥T1b期肾癌患者实施后腹腔镜下选择性肾动脉分支阻断保留肾单位手术是一种安全有效的手术方法,能够在术后早期很好地保护患者患肾功能,且不会增加术中出血量和术后并发症。Objective To investigate the safety and efficacy of retroperitoneal laparoscopic selective renal artery branch occlusion with nephron sparing surgery in patients with renal carcinoma of stage≥T1b.Methods From July 2016 to September 2020,35 patients with renal cancer≥T1b underwent retroperitoneoscopic nephron sparing surgery in the First Affiliated Hospital of Shenzhen University.The surgical methods were retroperitoneoscopic nephron sparing surgery with total renal artery occlusion(group A)or selective renal artery branch occlusion(group B).Operation time,heat ischemia time,blood transfusion rate,positive margin rate,intraoperative blood loss,postoperative complications and length of hospital stay were compared between the two groups,and the total glomerular filtration rate(GFR)and the single-nephron glomerular filtration rate(sGFR)of the offected kidneys were compared between the two groups before,3 months after and 12 months after surgery.Results Among the 35 patients,19 were male and 16 were female,aged(55.7±8.4)years and the body mass index is(24.6±3.1)kg/m2.The tumor diameter was(54.7±10.3)mm.The difference was statistically significant of operative time between group A and B[(103.5±14.3)vs(123.2±14.1)min,P=0.003].There were no significant differences in thermal ischemia time,blood transfusion rate,positive margin,intraoperative blood loss,incidence of postoperative complications and length of hospital stay between the two groups(all P>0.05).The decrease of renal sGFR in the group A was significantly higher than group B at 3 months and 12 months after surgery[(23.1±3.6)vs(29.1±7.1)ml/min;(25.9±4.7)vs(30.7±7.2),both P<0.05].Conclusion Retroperitoneal laparoscopic selective renal artery branch occlusion and neon-sparing surgery for patients with≥T1b stage renal carcinoma is a safe and effective surgical method,which can well protect the renal function of patients in the early postoperative stage without increasing intraoperative blood loss and postoperative complications.

关 键 词：肾肿瘤 癌 肾细胞 保留肾单位手术 肾动脉阻断 疗效 

分 类 号：R737.11[医药卫生—肿瘤]