最小血流阻断技术联合3D打印在腹腔镜下保留肾单位手术中的应用效果  

Efficacy of minimum blood flow occlusion combined with 3D printing in laparoscopic nephron sparing surgery

作　　者：杨凌博 吕文伟 胡国森 孙建涛 魏澎涛 YANG Lingbo;LYU Wenwei;HU Guosen;SUN Jiantao;WEI Pengtao(Department of Urology Surgery,Luoyang Central Hospital Affiliated to Zhengzhou University,Luoyang,Henan 471000)

机构地区：[1]郑州大学附属洛阳中心医院泌尿外科,河南洛阳471000

出　　处：《郑州大学学报(医学版)》2025年第2期234-237,共4页Journal of Zhengzhou University(Medical Sciences)

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20210846)。

摘　　要：目的:探讨最小血流阻断技术联合3D打印应用于腹腔镜下保留肾单位手术的有效性及安全性。方法:选择2018年1月至2020年12月郑州大学附属洛阳中心医院收治的52例肾癌行部分切除手术的患者,分为两组,A组30例,采用最小血流阻断技术联合3D打印行腹腔镜下肾部分切除术,B组22例,采用高选择性肾动脉阻断技术联合3D打印行腹腔镜下肾部分切除术。比较两组患者的手术时间、肾动脉分支阻断时间、术中出血量、术后肾功能损伤程度(术后24 h内血肌酐较术前升高值)、术后1 d疼痛评分及并发症发生率等。结果:A组手术时间[(63.1±6.5)min vs(94.4±11.6)min]、术中出血量[(30.2±16.3)mL vs(55.7±13.4)mL]、肌酐升高值[(36.0±22.7)μmol/L vs(54.0±20.7)μmol/L]、术后1 d疼痛评分[(4.1±2.2)vs(5.1±3.7)]及术后并发症发生率(10.0%vs 36.4%)均低于B组,B组肾动脉阻断时间较A组缩短[(17.5±3.1)min vs(20.3±3.6)min]。两组均无手术切缘阳性患者,术后常规随访24~48个月,均未见肿瘤复发及转移,术后1个月后肾功能均恢复正常。结论:最小血流阻断技术联合3D打印应用于腹腔镜下保留肾单位手术可以缩短手术时间、减少出血量,降低围手术期并发症发生率。Aim:To explore the safety and effectiveness of minimum blood flow occlusion combined with 3D printing in laparoscopic nephron sparing surgery.Methods:Fifty-two patients with renal cancer undergoing partial resection admitted to Luoyang Central Hospital Affiliated to Zhengzhou University from January 2018 to December 2020 were allocated into 2 groups.Thirty patients(group A)accepted laparoscopic partial nephrectomy by minimal blood flow occlusion combined with 3D printing,and 22 patients(group B)accepted laparoscopic partial nephrectomy by highly selective renal artery occlusion combined with 3D printing.The operative time,renal artery branch occlusion time,intraoperative blood loss,postoperative renal function injury(the change of serum creatinine 24 hours after surgery and before surgery),VAS score 1 day after surgery and complication rate were compared between the 2 groups.Results:In group A,the operative time[(63.1±6.5)min vs(94.4±11.6)min],intraoperative blood loss[(30.2±16.3)mL vs(55.7±13.4)mL],the change of serum creatinine[(36.0±22.7)μmol/L vs(54.0±20.7)μmol/L],NRS score 1 day after surgery[(4.1±2.2)vs(5.1±3.7)],and complication rate(10.0%vs 36.4%)were lower than those of group B(P<0.05),while the renal artery occlusion time in group A was long than that in group B[(20.3±3.6)min vs(17.5±3.1)min](P<0.05).No patients in the 2 groups had positive surgical margins.No tumor recurrence or metastasis was observed during 24 to 48 months follow-up after surgery,and renal function returned to normal 1 month after surgery.Conclusion:In laparoscopic nephron sparing surgery,minimum blood flow occlusion combined with 3D printing greatly shortens the operation time,reduce the amount of blood loss,and reduce the incidence of perioperative complications.

关 键 词：最小血流阻断技术 高选择性肾动脉阻断技术 保留肾单位手术 

分 类 号：R737.11[医药卫生—肿瘤]