腹腔镜零缺血肾部分切除术治疗T1a期肾癌的可行性及安全性分析  

Feasibility and safety analysis of laparoscopic partial ischaemic nephrectomy for T1a stage renal carcinoma

作　　者：张鹏 李志刚[1,2] 庞昆 韩从辉[1,2] 张有为[3] 臧光辉 刘林[2] Zhang Peng;Li Zhigang;Pang Kun;Han Conghui;Zhang Youwei;Zang Guanghui;Liu Lin(Graduate School of Bengbu Medical College,Bengbu 233030,China;Department of Urology,Xuzhou Central Hospital,Xuzhou 221009,China;Department of Medical Oncology,Xuzhou Central Hospital,Xuzhou 221009,China)

机构地区：[1]蚌埠医学院研究生院,蚌埠233030 [2]徐州市中心医院泌尿外科,徐州221009 [3]徐州市中心医院肿瘤内科,徐州221009

出　　处：《国际泌尿系统杂志》2024年第2期216-219,共4页International Journal of Urology and Nephrology

基　　金：徐州市引进临床医学专家团队项目(2018TD004);2020年度徐州市临床技术骨干研修计划项目(2020GG020)。

摘　　要：目的分析腹腔镜零缺血肾部分切除术的可行性及安全性,以期为T1a期肾癌的手术治疗探索安全有效、对肾功能影响更小的方法。方法回顾性分析2017年7月至2021年12月于徐州市中心医院泌尿外科行腹腔镜肾部分切除术(LPN)的80例T1a期(肿瘤长径≤4 cm、外向型生长、远离集合系统)肾癌患者的临床资料。根据手术中是否阻断肾动脉,分为肾动脉阻断组(术中常规行肾动脉阻断)和零缺血组(术中不阻断肾动脉或只阻断供应肿瘤的二级血管),每组40例。比较两组的手术时间、术中出血量、手术前后肾小球滤过率(GFR)、住院时间。结果两组患者术中术后均未输血,术后切缘均为阴性。肾动脉阻断组的术中出血量低于零缺血组,差异有统计学意义(P<0.001);肾动脉阻断的术后24 h肾小球滤过率低于零缺血组,差异有统计学意义(P<0.001)。术后随访12~39个月,患侧肾功能均正常,无肿瘤复发及转移发生。结论腹腔镜零缺血肾部分切除术可最大程度减少肾脏热缺血时间,保护患肾功能,是一种安全有效的治疗T1a期肾癌的手术方式。Objective To analyze the feasibility and safety of laparoscopic zero ischemia partial nephrectomy,with the aim of exploring safe and effective methods for the surgical treatment of T1a stage renal cancer with less impact on renal function.Methods Clinical data of 80 renal cancer patients with T1a stage(tumor length diameter≤4 cm,outward growth,away from the collecting system)who underwent laparoscopic partial nephrectomy(LPN)from July 2017 to December 2021 in the department of urology,Xuzhou Central Hospital were were retrospectively analyzed.According to whether renal artery was blocked during operation,the patients were divided into renal artery block group(renal artery block was routinely performed during operation)and zero ischemia group(renal artery was not blocked during operation or only secondary blood vessels supplying tumor),with 40 cases in each group.The operative time,intraoperative blood loss,glomerular filtration rate(GFR)before and after operation and length of hospital stay were compared between the two groups.Results There was no intraoperative and postoperative blood transfusion in both groups,and the postoperative margins were negative.The intraoperative bleeding in the renal artery blockade group was lower than that in the zero ischemia group,and the differences were statistically significant(P<0.001).The postoperative glomerular filtration rate at 24 h after operation was lower than that in the zero ischemia group,and the difference was statistically significant(P<0.001).At 12-39 months of postoperative follow-up,the renal functions of the affected side were normal,and no tumor recurrence and metastasis occurred.Conclusions Laparoscopic partial nephrectomy with zero ischemia is a safe and effective surgical method for T1a renal cancer,which can reduce the renal thermal ischemia time to the greatest extent and protect renal function.

关 键 词：肾肿瘤 腹腔镜检查 肾切除术 

分 类 号：R737.11[医药卫生—肿瘤]