腹腔镜下肾部分切除术中半程阻断技术治疗肾门部肿瘤23例报告  

Laparoscopic Partial Nephrectomy With Early Unclamping Technique in the Treatment of Renal Hilar Tumors: a Report of 23 Cases

作　　者：吴旺宇 赵余祥 马嘉兴[1] 耿浩[1] 钱伟伟 于德新[1] 张涛[1] Wu Wangyu;Zhao Yuxiang;Ma Jiaxing(Department of Urology,Second Hospital of Anhui Medical University,Hefei 230601,China)

机构地区：[1]安徽医科大学第二附属医院泌尿外科,合肥230601

出　　处：《中国微创外科杂志》2022年第11期884-887,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：安徽省自然科学基金(2008085MH290);安徽医科大学第二附属医院博士科研基金(2018BSJJ012);安徽医科大学第二附属医院临床研究培育计划项目(2020LCYB20)。

摘　　要：目的探讨腹腔镜下肾部分切除术中应用半程阻断技术治疗肾门部肿瘤的安全性和可行性。方法2015年10月~2020年10月我院对23例肾门部肿瘤行半程阻断腹腔镜肾部分切除术,在肾部分切除术中,阻断肾动脉状态下切除肿瘤,然后对基底部创面行第一层缝扎止血,松开肾动脉阻断后,再进行肾脏集合系统(如有损伤)的修补和外层肾实质的连续缝合。结果23例手术均顺利完成,无中转根治性肾切除术或开放手术。手术时间(134.7±36.4)min,热缺血时间(18.3±6.4)min,术中出血量(108.3±82.6)ml,Clavien-DindoⅠ~Ⅱ级并发症3例。术后病理:18例透明细胞癌,3例乳头状癌,2例嫌色细胞癌,手术标本切缘均为阴性。术后3个月血肌酐明显高于术前(P=0.017),患肾肾小球滤过率明显小于术前(P=0.000)。23例中位随访时间12个月(3~24个月),均无肿瘤复发和转移。结论对于肾门部肿瘤,半程阻断技术安全可行,值得推广。Objective To explore the safety and feasibility of laparoscopic partial nephrectomy with early unclamping technique in the treatment of renal hilar tumor.Methods We retrospectively collected data of 23 patients with renal hilar tumor who underwent laparoscopic partial nephrectomy with early unclamping technique in our hospital from October 2015 to October 2020.During the surgery,the tumor was removed when the renal artery was blocked,and then the first layer of suture was performed for hemostasis on the wound at the base.After the renal artery was released,the renal collecting system(if damaged)was repaired and the outer renal parenchyma was continuously sutured.Results All the 23 surgeries were completed successfully without conversion to radical nephrectomy or open surgery.The operation time was(134.7±36.4)min,the warm ischemia time was(18.3±6.4)min,and the intraoperative blood loss was(108.3±82.6)ml.There were 3 cases of gradeⅠ-ⅡClavien-Dindo complications.Postoperative pathology showed 18 cases of clear cell carcinoma,3 cases of papillary carcinoma,and 2 cases of chromophobe cell carcinoma.The incisional margins of surgical specimens were negative.Three months after operation,serum creatinine was significantly higher than that before operation(P=0.017),and the glomerular filtration rate of affected kidney was significantly lower than that before operation(P=0.000).The median follow-up time of the 23 cases was 12 months(range,3-24 months),and none of them had tumor recurrence or metastasis.Conclusion During laparoscopic partial nephrectomy for renal hilar tumor,the early unclamping technique is safe and feasible,which is worthy of promoting.

关 键 词：肾部分切除术 半程阻断技术 热缺血时间 肾功能 

分 类 号：R737.11[医药卫生—肿瘤]