腹腔镜肾部分切除术治疗中高复杂程度肾肿瘤的效果  

Treatment outcome of laparoscopic partial nephrectomy in patients with renal tumors of moderate to high complexity

作　　者：邱敏[1] 宗有龙 王滨帅[1] 杨斌[1] 徐楚潇 孙争辉 陆敏[3] 赵磊[1] 卢剑[1] 刘承[1] 田晓军[1] 马潞林[1] QIU Min;ZONG You-long;WANG Bin-shuai;YANG Bin;XU Chu-xiao;SUN Zheng-hui;LU Min;ZHAO Lei;LU Jian;LIU Cheng;TIAN Xiao-jun;MA Lu-lin(Department of Urology,Peking University Third Hospital,Beijing 100191,China;Department of Urology,Yan’an Hospital of Traditional Chinese Medicine/Yan’an Branch of Peking University Third Hospital,Yan’an 716000,Shaanxi,China;Department of Pathology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院泌尿外科,北京100191 [2]延安市中医医院/北京大学第三医院延安分院泌尿外科,陕西延安716000 [3]北京大学第三医院病理科,北京100191

出　　处：《北京大学学报（医学版）》2023年第5期833-837,共5页Journal of Peking University:Health Sciences

摘　　要：目的:探讨腹腔镜肾部分切除术治疗中高复杂程度(R.E.N.A.L.评分7~10分)肾肿瘤的效果。方法:选取北京大学第三医院2016年2月至2021年4月行腹腔镜肾部分切除术的R.E.N.A.L.评分为7~10分的肾肿瘤患者186例,所有患者均在完善检查后行腹腔镜肾部分切除术。对患者进行随访,记录术后血红蛋白、血肌酐、并发症、住院时间等。数据用均数±标准差或中位数(范围)表示。结果:本组男128例、女58例,年龄(54.6±12.8)岁,体重指数(25.4±3.4)kg/m 2;肿瘤位于左侧95例、右侧91例,肿瘤最大径(3.1±1.2)cm。患者术前血红蛋白(142.9±15.8)g/L,血肌酐78μmol/L(47~149μmol/L)。根据术前CT影像进行R.E.N.A.L.评分:7分43例,8分67例,9分53例,10分23例。所有手术均顺利完成,有12例中转开放手术。手术时间150 min(69~403 min),热缺血时间25 min(3~60 min),术中出血量30 mL(5~1500 mL),有9例输血,输血量800 mL(200~1200 mL)。术后血红蛋白(126.2±17.0)g/L,术后血肌酐83.5μmol/L(35~236μmol/L),住院时间6 d(3~26 d),手术效果达到“三连胜”87例(46.8%)。有167例得到随访,随访时间12个月(1~62个月),其中复发伴转移1例,转移4例,合并其他肿瘤2例(死亡1例)。结论:腹腔镜肾部分切除术治疗R.E.N.A.L.评分为7~10分的肾肿瘤是安全且有效的,基于肿瘤的复杂性,随着难度的增加,阻断时间和手术时间有逐渐增加的趋势,“三连胜”比例逐渐降低;腹腔镜肾部分切除术并发症较少,能较好地达到最大限度保留肾功能的目的。Objective:To investigate the treatment outcome of laparoscopic partial nephrectomy in the patients with renal tumors of moderate to high complexity(R.E.N.A.L.score 7-10).Methods:In the study,186 patients with a renal score of 7-10 renal tumors who underwent laparoscopic partial nephrectomy in Peking University Third Hospital from February 2016 to April 2021 were selected.Laparoscopic partial nephrectomy was performed after examination.The patients were followed-up,and their postoperative hemoglobin,creatinine,complications,and length of hospital stay recorded.The data were represented by mean±standard deviation or median(range).Results:There were 128 males and 58 females in this group,aged(54.6±12.8)years,with body mass index of(25.4±3.4)kg/m 2;The tumors were located in 95 cases on the left and 91 cases on the right,with maximum diameter of(3.1±1.2)cm.The patient’s preoperative hemoglobin was(142.9±15.8)g/L,and blood creatinine was 78μmol/L(47-149μmol/L).According to preoperative CT images,the R.E.N.A.L.score was 7 points for 43 cases,8 points for 67 cases,9 points for 53 cases,and 10 points for 23 cases.All the ope-rations were successfully completed,with 12 cases converted to open surgery.The operation time was 150 minutes(69-403 minutes),the warm ischemic time was 25 minutes(3-60 minutes),and the blood loss was 30 mL(5-1500 mL).There were 9 cases of blood transfusions,with a transfusion volume of 800 mL(200-1200 mL).Postoperative hemoglobin was(126.2±17.0)g/L.The preoperative crea-tinine was 78μmol/L(47-149μmol/L),the postoperative creatinine was 83.5μmol/L(35-236μmol/L),the hospital stay was 6 days(3-26 days),and surgical results achieved“the trifecta”in 87 cases(46.8%).In the study,167 cases were followed up for 12 months(1-62 months),including 1 case with recurrence and metastasis,4 cases with metastasis,and 2 cases with other tumors(1 case died).Conclusion:Laparoscopic partial nephrectomy is safe and effective in the treatment of renal tumors with R.E.N.A.L.score of 7-10.Based on the com

关 键 词：肾肿瘤 腹腔镜检查 肾部分切除术 治疗结果 

分 类 号：R737.11[医药卫生—肿瘤]