机构地区:[1]湖南中医药高等专科学校附属第一医院泌尿外科,株洲412000
出 处:《国际泌尿系统杂志》2024年第1期37-41,共5页International Journal of Urology and Nephrology
摘 要:目的探讨分析急诊行选择性肾动脉栓塞术(SAE)对急性肾错构瘤破裂出血患者术后恢复的影响。方法选择2019年4月至2021年9月本院收治的急性肾错构瘤破裂出血患者65例, 根据不同的治疗方式将患者分为两组, 其中30例术前行急诊SAE的患者设为SAE组, 而35例未行急诊SAE, 直接行腹腔镜肿瘤剜除术的患者设为非SAE组。比较两组患者的手术相关情况、术中应激反应指标、手术前后的肾功能指标变化以及术后并发症的发生情况。结果 SAE组患者的术中出血量、手术时间、肾动脉阻断时间、术后胃肠功能恢复时间以及术后住院时间均显著低于非SAE组(均P<0.05)。SAE组患者的术中血肾素、肾上腺素以及去甲肾上腺素水平均显著低于非SAE组(均P<0.05)。术前两组患者的肾功能指标血清肌酐(Scr)、估算肾小球滤过率(eGFR)水平比较, 差异均无统计学意义(均P>0.05);术后3个月两组患者的Scr均较术前显著升高, eGFR均较术前显著降低(均P<0.05), 而术后3个月SAE组患者的Scr显著低于非SAE组, eGFR显著高于非SAE组(均P<0.05)。两组患者并发症发生率比较, 差异无统计学意义[6.67% (2/30)vs. 8.57%(3/35), P>0.05]。结论对急性肾错构瘤破裂出血患者行急诊SAE后, 择期行腹腔镜下肿瘤剜除术, 可有效缩短手术时间及术中肾动脉阻断时间, 降低患者术中应激水平, 有利于患者的术后恢复以及肾功能保护, 值得临床应用。Objective To explore and analyze the effect of emergency selective renal artery embolization on postoperative recovery of patients with acute renal hamartoma rupture and hemorrhage.Methods From April 2019 to September 2021,65 patients with acute renal hamartoma rupture and bleeding admitted to our hospital were selected.According to the different treatment methods of patients,30 patients with emergency SAE before operation were selected as SAE group,while 35 patients with laparoscopic tumor enucleation without emergency SAE were selected as non SAE group.The operation related conditions,intraoperative stress response indexes,changes of renal function indexes before and after operation and postoperative complications were compared between the two groups.Results The intraoperative blood loss,operation time,renal artery occlusion time,postoperative gastrointestinal function recovery time and postoperative hospital stay in the SAE group were significantly lower than those in the non-SAE group(all P<0.05).Intraoperative blood renin,epinephrine and norepinephrine levels in the SAE group were significantly lower than those in the non SAE group(all P<0.05).There was no significant difference in the levels of renal function indexes Scr and eGFR between the two groups before operation(all P>0.05).At 3 months after operation,Scr in the two groups was significantly higher than that before operation(all P<0.05).The eGFR of patients in both groups was significantly lower than that before operation(all P<0.05),while the Scr of patients in SAE group was significantly lower than that of non SAE group at 3 months after operation,and the eGFR of patients in SAE group was significantly higher than that of patients at 3 months after operation non SAE group(all P<0.05).There was no significant difference in the incidence of complications between the two groups[6.67%(2/30)vs.8.57%(3/35),P>0.05].Conclusions For patients with renal hamartoma rupture and bleeding after emergency SAE,laparoscopic tumor enucleation can effectively shorten t
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