腹腔镜下肾部分切除术联合改良肾动脉灌注技术治疗复杂性肾肿瘤的疗效分析  

Effect analysis of laparoscopic partial nephrectomy combined with modified renal artery perfusion in the treatment of complex renal tumors

作　　者：王金行 郭园园[1] 孙巍 高五岳 刘建民[1] 刘贝贝[1] WANG Jinhang;GUO Yuanyuan;SUN Wei;GAO Wuyue;LIU Jianmin;LIU Beibei(Department of Urology,the First Affliated 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：《中华全科医学》2023年第9期1461-1465,共5页Chinese Journal of General Practice

基　　金：安徽省高校自然科学研究项目(KJ2017A244);蚌埠医学院研究生科研创新计划项目(Byycxz22067);蚌埠医学院第一附属医院领先新技术项目(2022094)。

摘　　要：目的 探讨改良肾动脉低温灌注技术辅助腹腔镜肾部分切除术(LPN)治疗复杂性肾肿瘤的安全性、可行性及近期疗效。方法 选取蚌埠医学院第一附属医院泌尿外科于2021年10月—2022年10月期间行LPN治疗的50例复杂性肾肿瘤患者,其中行LPN联合改良肾动脉低温灌注作为研究组(20例),未联合改良肾动脉低温灌注作为对照组(30例)。比较2组手术相关指标、肾功能指标及并发症发生情况。对肿瘤旁肾脏正常组织切片进行HE染色,观察镜下组织缺血缺氧变化。结果 与对照组比较,研究组肾功能指标术后总GFR下降值、患侧GFR下降值低于对照组[(8.81±2.50) mL/min vs.(14.48±2.90) mL/min,(9.37±2.50) mL/min vs.(14.38±1.80)mL/min,均P<0.05];研究组术中肾脏温度、术中出血量明显低于对照组[(21.18±2.34)℃vs.(32.48+1.13)℃、(105.00±30.17)mL vs.(141.30±57.00)mL,均P<0.05];镜下组织HE染色评分研究组低于对照组[(2.98±0.66)分vs.(4.07±0.66)分,P<0.05]。2组冷灌注/肾动脉阻断时间、体温、手术时间、术后住院时间等比较差异无统计学意义(均P>0.05)。结论 LPN联合改良肾动脉灌注在治疗复杂性肾肿瘤中可以降低出血量,减轻炎症反应,保护肾功能。Objective To evaluate the safety,feasibility and short-term efficacy of laparoscopic partial nephrectomy(LPN)combined with modified renal artery perfusion in the treatment of complex renal tumors.Methods Fifty patients with complex renal tumors treated with LPN in the Department of Urology of the First Affiliated Hospital of Bengbu Medical College from October 2021 to October 2022 were selected,in which LPN combined with modified renal artery cryogenic perfusion was used as the study group(20 cases),and not combined with modified renal artery cryogenic perfusion was used as the control group(30 cases).Operation related indexes,renal function indexes and complications were compared between the two groups.H&E staining were performed on the slices of normal kidney tissues adjacent to the tumor to observe the changes of ischemia and hypoxia under the microscope.Results Compared with the control group,the decrease of total GFR and CFR on the affected side of renal function index in the study group after operation were lower[(8.81±2.50)mL/min us.(14.48±2.90)mL/min,(9.37±2.50)mL/min vs.(14.38±1.80)mL/min,P<0.01].The intraoperative renal temperature and blood loss in the study group were significantly lower than those in the control group[(21.18±2.34)℃us.(32.48±1.13)℃,(105.00±30.17)mL us.(141.30±57.00)mL,all P<0.05].Pathological score of microscopic tissue inflammatory changes in the study group was significantly lower than that in the control group[(2.98±0.66)points us.(4.07±0.66)points,P<0.05],the expression of IL-18 and NAG in the study group was lower than that in the control group in immunohistochemistry.There were no significant differences in cold perfusion/renal artery occlusion time,body temperature,operation time and postoperative hospital stay between the two groups(all P>0.05).Conclusion LPN combined with modified renal artery perfusion can reduce blood loss,reduce inflammation and protect renal function in the treatment of complex renal tumors.

关 键 词：腹腔镜肾部分切除术 肾动脉低温灌注技术 复杂性肾肿瘤 

分 类 号：R737.11[医药卫生—肿瘤] R730.56[医药卫生—临床医学]