超选择性经动脉栓塞术在零缺血机器人辅助腹腔镜肾部分切除术中的应用  

Superselective transarterial embolization in robotic-assisted laparoscopic partial nephrectomy

作　　者：李海畅 祁小龙[2] 刘锋[2] 王帅[2] 沃奇军[2] 张大宏[2] Li Haicheng

机构地区：[1]浙江中医药大学第二临床医学院,310053 [2]浙江省人民医院(杭州医学院附属人民医院),310014

出　　处：《浙江临床医学》2024年第8期1129-1131,1135,共4页Zhejiang Clinical Medical Journal

摘　　要：目的探讨T1期肾癌术前超选择性经动脉栓塞后机器人辅助腹腔镜肾部分切除术的可行性和安全性。方法回顾性分析2015年5月至2022年3月207例机器人辅助腹腔镜肾部分切除术(RALPN)患者的临床资料,根据术前不同干预方式分为STE+RALPN组32例、Off-clamp RALPN组35例、S-RALPN组140例。比较各组术后肾功能、尿常规、CT、术前及术后肾小球滤过率(GFR)等指标。结果三组患者手术时间、失血量、术后24 h血红蛋白下降、引流管清除时间、手术前后GFR的下降比较,差异有统计学意义(P<0.05)。STE+RALPN组患者无尿漏、低体温、发热等治疗相关不良反应。无复发或转移发生。结论肾动脉栓塞后的机器人辅助腹腔镜下零缺血肾部切除可保留更多的残肾功能,并发症少,提供一种安全可行的手术方法。Objective To assess the feasibility and safety of zero ischemia robotic-assisted laparoscopic partial nephrectomy(RALPN)after preoperative superselective transarterial embolization(STE)of T1 renal cancer.Methods The clinical data of 207 patients undergoing robot-assisted laparoscopic partial nephrectomy(RALPN)were retrospectively analysed,and they were divided into 32 cases in the STE+RALPN group,35 cases in the Off-clamp RALPN group,and 140 cases in the S-RALPN group according to the different interventions in the preoperative period.The intraoperative data and postoperative complications were recorded.The postoperative renal function,routine urine test,urinary Computed Tomography(CT),and preoperative and postoperative glomerular filtration rate(GFR)data were analyzed.Results Comparison of the mean operation time,mean blood loss,postoperative 24 h hemoglobin drop,mean drain clearance time,and the drop in GFR before and after the operation among the three groups of patients showed statistically significant differences(P<0.05).There were no treatment-related adverse reactions such as urinary leakage,hypothermia,fever,etc,in the patients in the STE+RALPN group.No recurrence or metastasis occurred.Conclusion STE of renal tumors in zero ischemia RALPN can preserve more renal function,and it provides a safe and feasible surgical method.

关 键 词：超选择性肾动脉栓塞 零缺血 部分肾切除术 机器人辅助腹腔镜手术 

分 类 号：R737.11[医药卫生—肿瘤]