局限性肾癌后腹腔镜下两种肾动脉处理策略可行性分析及对肾功能的影响  

Feasibility analysis and effects on renal function of two retroperitoneal aparoscopic renal artery treatment strategies for localized renal carcinoma

作　　者：余明主 谭公祥 曹卫霞 陈亚梅 郑慧杰 余春艳 余翥 刘明 YU Mingzhu;TAN Gongxiang;CAO Weixia(Department of Urology,908 Hospital of Joint Logistic Support Force,Nanchang 330002,China;Department of Urology,Nanchang Fifth Hospital)

机构地区：[1]联勤保障部队第908医院泌尿外科,江西南昌330002 [2]南昌市第五医院泌尿外科

出　　处：《腹腔镜外科杂志》2024年第12期925-930,共6页Journal of Laparoscopic Surgery

基　　金：江西省卫健委科技计划课题(SKJP220227065)。

摘　　要：目的:分析局限性肾癌行后腹腔镜手术中两种肾动脉处理策略的可行性及对肾功能的影响。方法:回顾性纳入2021年1月至2023年6月104例行腹腔镜肾部分切除术的患者,52例行高选择性肾动脉阻断(HSRAO),52例行超选择性肾分支动脉栓塞(SRBAE)。对比分析两组肾脏热缺血情况、手术常规指标、术前、术后第7天与术后3个月患肾肾功能指标(尿素氮、血肌酐、肾小球滤过率)及健侧肾肾小球滤过率、并发症、复发率,比较两组不同分期患者的患肾功能。结果:SRBAE组中51例零缺血,HSRAO组肾脏热缺血时间(22.80±2.57)min;SRBAE组手术时间短于HSRAO组,术中出血<100 mL的患者占比高于HSRAO组(P<0.05);两组术前、术后第7天、术后3个月患肾尿素氮、血肌酐、肾小球滤过率及术后3个月健侧肾肾小球滤过率差异无统计学意义(P>0.05);两组并发症差异无统计学意义(P>0.05);HSRAO组T_(1)期患者患肾术后第7天、术后3个月尿素氮、血肌酐、肾小球滤过率与术前相比差异无统计学意义(P>0.05);HSRAO组T_(2)期患者患肾术后第7天、术后3个月尿素氮、血肌酐高于术前,术后3个月肾小球滤过率低于术前(P<0.05);SRBAE组T_(1)期、T_(2)期术后第7天、术后3个月尿素氮、血肌酐、肾小球滤过率与术前相比差异无统计学意义(P>0.05)。结论:HSRAO或SRBAE后腹腔镜肾部分切除术均是可行、有效的,后者在改善肾脏热缺血方面具有优势,能缩短手术时间、减少出血,利于改善T_(2)分期患者的术后患肾功能。Objective:To analyze the feasibility and influence on renal function of two retroperitoneal laparoscopic renal artery treatment strategies for localized renal carcinoma.Methods:A total of 104 patients who underwent laparoscopic partial nephrectomy from Jan.2021 to Jun.2023 were included retrospectively.Among them,there were 52 cases of highly selective renal artery occlusion(HSRAO)and 52 cases of super-selective renal branch artery embolization(SRBAE).The renal thermal ischemia,routine surgical i ndexes,renal function indexes of the affected kidney(urea nitrogen,blood creatinine,glomerular filtration rate)preoperatively,7 d postoperatively,and 3 months postoperatively,and glomerular filtration rate of the healthy kidney,complications,and recurrence rate in the two groups were compared.Renal function indexes of the affected kidneys in the two groups at different stages were compared.R esults:There were 51 cases of zero ischemia in the SRBAE group,and the renal thermal ischemia time in the HSRAO group was(22.80±2.57)min.The operation time in the SRBAE group was shorter than that in the HSRAO group,and the percentage of patients with intraoperative hemorrhage<100 mL in the SRBAE group was higher than that in the HSRAO group(P<0.05).The preoperative,postoperative 7 d,and postoperative 3 months urea nitrogen,blood creatinine,glomerular filtration rate of the affected kidneys,and the glomerular filtration rate of the healthy kidney at 3 months postoperatively were not statistically significantly different between the two groups(P>0.05).The difference in complications between the two groups was not statistically significant(P>0.05).The differences in urea nitrogen,blood creatinine,and glomerular filtration rate of affected kidney at T_(1) stage 7 d after surgery and 3 months after surgery were not statistically significant compared with the preoperative period in the HSRAO group(P>0.05).The urea nitrogen and blood creatinine of affected kidney at T_(2) stage 7 d after surgery and 3 months after surgery were higher than

关 键 词：肾肿瘤 局限性 肾动脉 肾功能 腹腔镜检查 腹膜后入路 

分 类 号：R737.11[医药卫生—肿瘤]