后腹腔镜下冷冻消融治疗小肾肿瘤的初步报告

Objective To present the technique and short-term results of retroperitoneal laparoscopic renal cryoablation for small renal tumors. Methods Ten selected patients cases with 11 renal tumors were included in present study. There were 3 cases of left renal tumor, 6 cases of right renal tumor and 1 case of bilateral renal tumors. Tumors were located at the upper pole (2), middle (6), or lower pole (3). All tumors were located distant from the collecting system, without evidence of metastatic disease. Mean tumor size was 2. 8 cm (range: 1.5-4.0). All the patients were managed with a double freeze-thaw cycle of retroperitoneal laparoscopic renal cryoablation. The preoperative Hb was (137± 21)g/L, ESR was (27±12)mm/1 h, SCr was (92±41)μmol/L, GFR was (42±10)ml/min.All the patients were taken routine biopsies. Results Cryoablation was technically successful in all 10 patients (11 tumors). The mean time of the operations was (101 ± 31) min, and the mean blood loss was (42±21) ml. None of the cases received blood transfusion post-operation. No operative complication was seen. The postoperative hospital stay was (4±2) d. The postoperative Hb was (129 ±18)g/L,ESR was (31±14)mm/1 h,SCr was (95±39)μmol/L,GFR was (40±11)ml/min. There was no statistic change of Hb, ESR, SCr and ECT-GFR after operations(P＞0. 05). The biopsy results revealed that 8 tumors were renal clear cell carcinomas, and 2 tumors were papillary renal cell carcinomas, and 1 tumor was renal angiomyolipoma. All the patients had a minimum follow-up of 6 months (mean 16, range 6 to 21). Follow-up magnetic resonance imaging at 1, 3, and 6 months identified the punched-out, nonenhancing, spontaneously resorbing, renal cryolesions. Follow-up biopsie of the cryoablated tumor site was negative in the only patient who have undergone the biopsy. No evidence of local or port-site recurrence was found, and no metastatic disease. Conclusions Retroperitoneal laparoscopic renal cryoablation for small renal tumors could be an accurate and effective intervention with a relatively low incidence of complications. Critical long-term data regarding laparoscopic renal cryoablation are awaited.     

后腹腔镜下冷冻消融治疗小肾肿瘤的初步报告

Objective To present the technique and short-term results of retroperitoneal laparoscopic renal cryoablation for small renal tumors. Methods Ten selected patients cases with 11 renal tumors were included in present study. There were 3 cases of left renal tumor, 6 cases of right renal tumor and 1 case of bilateral renal tumors. Tumors were located at the upper pole (2), middle (6), or lower pole (3). All tumors were located distant from the collecting system, without evidence of metastatic disease. Mean tumor size was 2. 8 cm (range: 1.5-4.0). All the patients were managed with a double freeze-thaw cycle of retroperitoneal laparoscopic renal cryoablation. The preoperative Hb was (137± 21)g/L, ESR was (27±12)mm/1 h, SCr was (92±41)μmol/L, GFR was (42±10)ml/min.All the patients were taken routine biopsies. Results Cryoablation was technically successful in all 10 patients (11 tumors). The mean time of the operations was (101 ± 31) min, and the mean blood loss was (42±21) ml. None of the cases received blood transfusion post-operation. No operative complication was seen. The postoperative hospital stay was (4±2) d. The postoperative Hb was (129 ±18)g/L,ESR was (31±14)mm/1 h,SCr was (95±39)μmol/L,GFR was (40±11)ml/min. There was no statistic change of Hb, ESR, SCr and ECT-GFR after operations(P＞0. 05). The biopsy results revealed that 8 tumors were renal clear cell carcinomas, and 2 tumors were papillary renal cell carcinomas, and 1 tumor was renal angiomyolipoma. All the patients had a minimum follow-up of 6 months (mean 16, range 6 to 21). Follow-up magnetic resonance imaging at 1, 3, and 6 months identified the punched-out, nonenhancing, spontaneously resorbing, renal cryolesions. Follow-up biopsie of the cryoablated tumor site was negative in the only patient who have undergone the biopsy. No evidence of local or port-site recurrence was found, and no metastatic disease. Conclusions Retroperitoneal laparoscopic renal cryoablation for small renal tumors could be an accurate and effective intervention with a relatively low incidence of complications. Critical long-term data regarding laparoscopic renal cryoablation are awaited.     

折叠式结石拦截器在经皮肾镜取石术中的应用

目的 探讨折叠式结石拦截器在经皮肾镜取石术(PCNL)治疗肾结石中的有效性和安全性.方法 回顾分析108例行PCNL肾结石患者临床资料.术中应用折叠式结石拦截器56例,未应用52例.2组患者性别、年龄、结石大小比较差异均无统计学意义(P＞0.05).比较2组在结石清除率、手术时间、术中出血量、住院天数和并发症等差异. 结果 2组结石清除率分别为94.6%(53/56)和82.7%(43/52),手术时间分别为112、142 min,出血量为205、245 ml,差异均有统计学意义(P＜0.05).2组住院时间分别为2.8、3.0 d,并发症发生率分别为16.1%(9/56)和15.4%(8/52),2组比较差异无统计学意义(P＞0.05). 结论折叠式结石拦截器使用简单、方便、安全,PCNL术中能有效阻止结石碎片下滑进入输尿管,提高结石清除率、缩短手术时间、减少手术出血量、不增加手术并发症.

Abstract：

Objective To evaluate the efficacy and safety of percutaneous nephrolitholomy with a PercSys accordion stone management device in the treatment of renal calculi. Methods The data of 108 patients with renal calculi who underwent PCNL were retrospectively analyzed. Outcomes of 56 patients who underwent PCNL with the PercSys accordion device (group A) were compared with the outcomes of 52 patients who underwent PCNL without the accordion device (group B). Clinical data including stone-free rate, operative time, estimated blood loss, length of hospital stay and complications were compared. Results The stone-free rates of group A and group B were 94. 6% and 82.7%, operative time was 112 min and 142 min, the mean blood loss was 205 ml and 245 ml, respectively. The differences between the 2 groups were significant(P＜0. 05). The length of hospital stay was 2.8 d and 3.0 d, the complication rates were 16.1 % and 15.4%. There was no significant difference between the 2 groups for these 2 aspects(P＞0. 05). Conclusions The PercSys accordion device can be easily inserted and deployed during PCNL. It successfully prevents antegrade stone fragment migration, increases the stone-free rate and reduces the operative time and blood loss.     

螺旋CT平扫测量肾实质体积和厚度评价慢性梗阻侧肾脏肾小球滤过率的价值

目的 探讨螺旋CT平扫测量肾实质体积和厚度判断梗阻侧肾小球滤过率(glomerular filtration rate,GFR)的价值,并比较2种肾实质形态学指标与梗阻侧GFR之间的关系.方法 利用螺旋CT平扫测量71例慢性单侧上尿路梗阻性疾病患者的肾实质体积和厚度.①肾实质体积测量:扫描双肾,逐层标示各横断面面积,结合扫描层厚计算肾实质体积,并计算梗阻侧肾实质体积占总的肾实质体积百分比(%CTvol).②肾实质厚度测量:选择包含肾脏集合系统的第一个和最后一个层面的内、外、后3个位置测量肾实质厚度,取平均值作为肾实质厚度,并计算梗阻侧肾实质厚度占总的肾实质厚度百分比(%CTt).采用99Tcm-DTPA肾动态显像技术,应用Gates法测定分肾及总的GFR值,计算梗阻侧肾GFR的百分比(%GFR),采用Pearson相关分析行%CTvol、%CTt与%GFR之间的相关分析.结果 71例患者%CTvol、%CTt与%GFR之间均有明显的相关性,r值分别为0.80(t=11.20,P＜0.05)和0.66(t=7.24,P＜0.05),直线回归方程分别为%GFR=0.05+0.80×%CTvol(F=125.48,P＜0.05)和%GFR=0.12+0.66×%CTt(F=52.36,P＜0.05).结论螺旋CT平扫测量肾实质体积和厚度可以作为临床上评价慢性梗阻侧肾GFR的方法,肾实质体积较肾实质厚度更准确.

Abstract：

Objective To evaluate the value of renal parenchymal volume and thickness by non-contrast spiral CT in evaluating the differential glomerular filtration rate (GFR) for chronic obstructed kidneys, and to compare the correlations between the two morphologic indices of renal parenchyma and the GFR for chronic obstructed kidneys. Methods Seventy-one patients who had a diagnosis of unilateral chronic upper urinary tract obstruction were included in this analysis. (1) The renal parenchymal volume was mea-sured by non-contrast spiral CT. Both kidneys were scanned by non-contrast spiral CT. The renal parenchymal area of each section was marked manually. Renal parenchymal volume was calculated as the sum of renal parenchymal area multiplied by the width of each section. The volume percentage of obstructed kidney (%CTvol) was also calculated. (2) Renal parenchymal thickness was measured on the first and last non-contrast CT image levels from the anterior, posterior and lateral locations of the kidney that clearly contained the collecting system. The mean of these measurements was defined as the renal parenchymal thickness. The differential renal parenchymal thickness of the obstructed kidney (%CTt) was defined as the percentage of the obstructed renal parenchymal thickness to the total renal parenchymal thickness for both kidneys. GFR was determined with 99Tcm-DTPA dynamic imaging system by Gates method. The differential GFR for obstructed kidney (%GFR) was the GFR percentage of obstructed kidney to the total GFR for both kidneys. The Pearson relation test was carried out between the %CTvol, %CTt and the %GFR respectively. Results %CTvol and %CTt correlated well with %GFR in chronic obstructed kidneys among the 71 test group patients. Pearson correlation coefficient r was 0.80 (t=11.20, P＜0.05) and 0.66 (t=7.24, P＜0.05), respectively. The linear correlation equation respectively was %GFR=0.05+0.80×%CTvol (F=125.48, P＜0.05) and %GFR=0.12+0.66×%CTt (F=52.36, P＜0.05). Conclusions Renal parenchymal volume and thickness by non-contrast spiral CT might be used as clinical practical parameters to evaluate the differential GFR for chronic obstructed kidneys. Renal parenchymal volume is more accurate than renal parenchymal thickness.     

保留肾单位手术治疗早期肾细胞癌疗效分析

目的 评价比较T1a和T1b期肾细胞痛患者行保留肾单位手术(NSS)的临床疗效.方法 回顾性分析1999年11月至2009年12月施行NSS治疗的101例T1期肾细胞癌患者临床资料,男性79例,女性22例,年龄28～79岁,平均52.3岁.根据肿瘤病理组织大小分为T1a期62例,T1b期39例.对两组患者一般资料、手术时间、术中出血量、术中输血率、术中肾动脉阻断率及阻断时间,以及术后并发症发生率、术后肿瘤复发转移及生存情况等进行统计学分析.结果 两组手术时间:T1a组为(151±80)min,T1b期为(158±50)min;术中出血量:T1a期(322±596)ml,T1b期(308±239)ml,两组比较差异无统计学意义(P=0.32和P=0.45).术后随访8～102个月(平均38.4个月),除T1b期患者中1例于术后36个月因肿瘤转移死亡外,其余100例患者无肿瘤复发.结论 对T1期肾细胞癌患者施行NSS可获得满意临床效果,且T1a与T1b期患者疗效相当.

Abstract：

Objective To investigate the safety and effect of nephron-sparing surgery (NSS)in treatment of T1a and T1b renal cell carcinoma. Methods Retrospective analyzed the clinical data of 101patients with T1 renal cell carcinoma underwent NSS from November 1999 to December 2009. Including 79male and 22 female with the mean age of 52. 3 years ( ranged 28 to 79 years). Based on tumor pathologic diameter, 101 patients were divided into T1a group with 62 patient and T1b group with 39 cases.Demographic,intraoperative, postoperative and follow-up data were compared between the 2 groups. Results The operation were performed successfully in all the 101 cases. The mean operation time was ( 151 ± 80)min in group T1a and ( 158 ±50)min in group T1b with no statistical difference (P =0.32). The mean blood loss was ( 322 ± 596) ml in group T1 a and (308 ± 239 ) ml in group T1 b ( P = 0. 45 ). Postoperative followup ranged from 8 to 102 months with a mean of 38.4 months. One patient in T1b group died of distant metastasis 36 months after operation. Others were no tumor recurred. Conclusion Nephron-sparing surgery is safe and effective for the treatment of T1a and T1b renal cell carcinoma.     

经皮肾镜技术治疗上尿路肿瘤的初步经验

目的 评价经皮肾镜技术在上尿路肿瘤中的应用效果.方法 2006年6月至2010年6月经皮肾镜治疗上尿路肿瘤患者8例(10侧).男6例(7侧),女2例(3侧).年龄52～72岁,平均61岁.孤立肾4例,慢性肾功能不全2例,双侧肾盂肿瘤2例.高级别肿瘤4侧,低级别肿瘤6侧.肿瘤直径0.5～3.5 cm,平均2.6 cm.患者均接受经皮肾镜激光或电刀肿瘤切除术,术中留置输尿管支架管,术后经肾造瘘管灌注化疗药物.结果 8例手术均获成功,手术时间45～95 min,平均73 min;术中出血量20～300 ml,平均50 ml,术后SCr水平较术前下降或无明显变化.随访10～36个月,采用CT、MRI及输尿管镜检观察肿瘤复发情况.1例死于肿瘤转移,2例肿瘤局部复发.余5例未见肿瘤复发.结论 经皮肾镜技术治疗上尿路肿瘤安全可行,手术效果良好,对不宜行肾输尿管切除术的上尿路肿瘤患者来说是一种良好的选择.

Abstract：

Objective To evaluate the application of percutaneous nephroscopy in the treatment of upper urinary tract transitional cell carcinoma, particularly renal pelvic carcinoma. Methods From June 2006 to June 2010, eight cases (with 10 sides) of renal pelvic carcinoma received percutaneous nephroscopy tumor resection. There were six males (with 7 sides) and two females (with 3 sides) in the study group. There were six cases with solitary kidney and two cases with bilateral renal pelvic tumors. There were four cases with high-grade tumors and six cases with low-grade tumors. The age of patients ranged from 52 to 72 yrs (average 61.2 yrs). Tumor sizes ranged from 0.5 to 3.5 cm (average 2.6 cm). Patients were treated with laser or electrocautery through percutaneous nephroscopy. A ureteral stent was placed in the patients after the procedure. Chemotherapy was administered postoperatively through the nephrostomy tube. Results All the operations were successfully completed uneventfully. The operative time was 45-95 min (average 73 min), estimated blood loss was 20-300 ml (average 50 ml). No remarkable differences were found in serum creatinine levels before and after operation. After 10 to 36 mon. follow-up by CT, MRI, and ureteroscopy, one patient died of tumor metastasis and two patients had local tumor recurrence. The remaining patients had no local recurrence. Conclusions Percutaneous nephroscopy in treating renal pelvic tumor is safe and feasible. This is a better choice for the renal pelvic carcinoma patients who are unsuitable for ureteronephrectomy.     

微创经皮肾镜取石术治疗孤立肾结石的疗效分析

目的 探讨微创经皮肾取石术(MPCNL)治疗孤立肾结石的临床疗效.方法 2000年8月至2010年8月,242例孤立肾结石患者接受MPCNL治疗.GFR 17～108 ml/min.SCr(108±20)μmol/L,高于正常者19例,平均(181±32)μmol/L.结石位于左侧116例,右侧126例,合并输尿管结石15例.结石大小1.1 cm× 1.8 cm～3.9 cm×5.8 cm. 结果平均手术时间68 min.一期结石清除率79.3%(192/242),残留结石≤4 mm者16例,残留结石5～19 mm者34例.二期MPCNL及ESWL术后1个月复查,结石总清除率88.0%(213/242).术后发热18例,输血21例,因术后严重出血行肾动脉造影及肾出血动脉超选择栓塞治疗10例,肾周血肿1例,气胸1例. 结论 MPCNL治疗孤立肾结石创伤小、并发症少、结石清除率高,应作为孤立肾结石患者的首选治疗方案之一.

Abstract：

Objective To report our experience with minimally invasive percutaneous nephrolithotomy (MPCNL) in treatment of renal calculi in solitary kidneys. Methods From August 2000 to August 2010, 242 patients with renal calculi in solitary kidneys were treated by MPCNL, the data were reviewed retrospectively. Results The mean operative time was 68 min, the clearance rates were 79.3% (192/242) after first session and 88. 0% (213/242) after second-look MPCNL and ESWL, respectively. Postoperative fever happened in 18 cases. Twenty-one cases required transfusion, 10 cases received angiography and embolization. One case experienced perirenal hematoma and 1 case had pneumatothorax. Conclusions MPCNL has the advantages of less bleeding, high clearance rate and short hospital stay. MPCNL is an effective and feasible treatment option for renal calculi in solitary kidneys and should be the first line choice.     

后腹腔镜手术治疗重复肾重复输尿管畸形九例报告

目的 探讨后腹腔镜手术治疗重复肾重复输尿管畸形的疗效.方法 回顾性分析9例重复肾重复输尿管患者的资料.男6例,女3例.年龄13～58岁,平均37岁.左侧5例,右侧2例,双侧2例(其中1例左侧输尿管3条,右侧2条).重复肾重复输尿管位于肾上极7例,下极2例.9例术前彩色多普勒超声、MRU、ⅣU或CTU检查确诊为重复肾.采用后腹腔镜下重复肾重复输尿管切除术.观察手术时间、术中出血量、术后住院天数和术中术后并发症及手术效果.结果 9例手术均获成功,术中均未发生周围脏器、血管损伤.手术时间65～125 min,平均87 min.出血量30～600 ml,平均112 ml.术后肠道功能恢复时间1～3 d,平均1.6 d;术后住院天数5～12 d,平均7 d.随访6～36个月,平均18个月0.原发病症状消失,残留半肾功能良好.结论 后腹腔镜下手术治疗重复肾重复输尿管畸形创伤小、并发症少、恢复快、疗效确切,可作为重复肾重复输尿管治疗的首选术式.

Abstract：

Objective To investigate the efficacy of retroperitoneal laparoscopic heminephroureterectomy for duplex kidney anomalies.Methods Retroperitoneoscopic heminephroureterectomy was performed on nine patients, six males and three females.The average age of the study group was 37 years ( range 13 to 58).Seven cases had anomalies on the upper kidney pole, two cases had anomalies on the lower kidney pole.Five anomalies were on the left side, two were on the right side and two were in bilateral sides (one special case had three ureters on the left side and two ureters on the right side ).Three cases complained of flank pain; two cases were found hydronephrosis by physical routine examination;Three cases complained of flank pain and fever; one cases complained of hematuria and kidney atones.All the cases were preoperatively diagnosed by color doppler ultrasound, MRU, IVP or CTU.Retroperitoneal laparoscopic heminephroureterectomy was performed on all patients.The operation time, blood loss, hospital stay, intraoperative and postoperative complications and efficacy were observed.Results All the retroperitoneal laparoscopic procedures were successfully completed.No intraoperative complications were found.The average operation time was 87 min (range, 65 to 125).The average blood loss was 112 ml (range, 30 to 600).The recovery times of intestinal function was 1.6 days ( range, 1 to 3 ).The average postoperative hospital stay was 7 days (range, 5 to 12).The syndrome disappeared and kidney function was normal at a mean followup of 18 monthes.Conclusions Retroperitoneal laparoscopic surgeries for duplex kidney has the benefits of being minimally invasive, fewer complications, quick recovery and certainty of efficacy.Retroperitoneal laparoscopic surgeries can be considered as a first operation method to treat duplex kidney anomalies.     

经腹肾癌根治术并系统性淋巴结清扫治疗肾细胞癌临床分析(附136例报告)

目的 评价经腹腔肾癌根治性肾切除术并系统性淋巴结清扫术的安全性和疗效.方法 回顾性分析2004年7月至2008年6月经腹直肌旁切口行根治性肾切除和系统性淋巴结清扫术治疗肾细胞癌136例患者的资料.男92例,女44例;年龄23～81岁,平均54岁.肿瘤最大径15～170 mm,平均55 mm.体检时B超检查发现66例(61%),以皮肤转移为首发症状者2例.术前均进行B超、CT及核素骨扫描检查,肿瘤临床分期:T1 108例,T2 14例,T3 12例,T4 2例.结果 本组手术时间90～180 min,平均120 min.出血量20～400 ml,平均50 ml.术后肠道功能恢复时间为(24±12)h,术后住院天数为(7±2)d.术后病理结果:肾透明细胞癌123例(90.4%),乳头状肾细胞癌6例(4.4%),嫌色细胞癌2例(1.4%),集合管癌2例(1.4%),其他3例(2.2%).淋巴结转移8例.T1期92例,T2期11例,T3期10例,T4期10例.95例(69.9%)获随访,随访时间6～40个月,平均20个月.1、3年生存率分别为95.8%(91/95)、86.3%(82/95).结论 系统性淋巴清扫肾癌根治术能有效切除肿瘤,可准确分期,防止局部复发,安全可靠,疗效良好.

Abstract：

Objective To assess the safety and efficacy of abdominal radical nephrectomy and systematic lymph node dissection for treatment of renal carcinoma. Methods A total of 136 patients underwent radical nephrectomy and regional clearance of lymph nodes from July 2004 to June 2008.There were 92 males and 44 females in the study group.Ages ranged from 23 to 81 years,with a mean age of 54 years.The mean tumor diameter was 55 mm (range,15-170 mm).The tumor size detected by CT and MRI was consistent with that detected by B-ultrasound,98 were stage Ⅰ,13stage Ⅱ,12 stage Ⅲ,and 2 stage Ⅳ. Results All 136 cases underwent radical nephrectomy with retroperitoneal lymphadenectomy.All operations were successful without any major complication.The operative time was 90 to 180 min,with an average of 120 min,and blood loss was 20-400 ml,with an average of 50 ml.The pathological diagnoses were as follows: renal cell carcinoma 123 cases (90%), papillary renal cell carcinoma six cases(4%),chromophobic two cases(1.4%),oncocytoma two cases(1.4%),collecting duct two(1.4%),and others three cases(2.2%).Eight cases reported positive lymph nodes.Of the 136 cases,92 cases were T1 N0 M0,11 were T2 N0 M0,10 were T3 N0 M0,eight were T3 N1 M0 and two were T1 N0 M1.Ninety-five cases (70%) were followed-up at six to 40 months (mean,20 months).The one year and three year survival rates were 96% (91/95) and 86% (82/95),respectively.Conclusions Radical nephrectomy with systematic lymph dissection has advantages of accurate staging,effective resecting of renal tumors and preventing recurrence.Radical nephrectomy is an effective method for the treatment of renal carcinoma.     

腹腔镜下左肾静脉外支架固定术治疗左肾静脉压迫综合征的临床分析

目的 探讨腹腔镜下左肾静脉外支架固定术治疗左肾静脉压迫综合征的临床疗效.方法 左肾静脉压迫综合征患者5例.男4例,女1例.年龄20～35岁,平均25岁.肉眼血尿3例,活动后加重,合并蛋白尿1例;左腰酸痛伴左精索静脉曲张2例.术前彩色多普勒超声及CT三维血管重建均提示左肾静脉压迫明显.扩张段与受压段直径比值均＞3.膀胱镜检查3例可见左输尿管口喷血尿.5例均于全麻下行腹腔镜下左肾静脉受压段外支架固定术治疗,术中用人造血管固定于下腔静脉与生殖静脉之间形成血管外支架以克服左肾静脉受压.结果 5例手术均顺利完成.手术时间65～70 min,平均67 min.术中出血量10～15 ml,平均13 ml.术中术后无明显外科并发症,术后恢复顺利,术后5～6 d出院.肉眼血尿消失3例,左精索静脉曲张减轻2例.术后随访9～39个月,平均28个月,1例术前肉眼血尿、术后仍有轻微镜下血尿,4例尿常规检查正常.5例其余症状均消失,超声检查示左肾静脉血流通畅、受压现象消失.结论 腹腔镜下左肾静脉外支架固定术采用人造血管环绕左肾静脉抵抗肠系膜上动脉压迫,是治疗左肾静脉压迫综合征的一种可供选择的微创技术,手术简单、方便、安全有效,创伤小、痛苦少、恢复快.

Abstract：

Objective To report the experience in the use of laparoscopic extravascular stent for the treatment of the nutcracker syndrome. Methods Five patients (4 men and 1 woman) aged 20 to 35 years (mean 25) underwent laparoscopic extravascular stent of the left renal vein (LRV) for treatment of nutcracker syndrome associated with severe recurrent gross hematuria and left gonadal vein varices. All patients met the criteria for establishing the diagnosis of nutcracker syndrome. Ultrasonography, computed tomography, and magnetic resonance imaging revealed visible entrapment of the LRV between the superior mesenteric artery and aorta. Bleeding from the left ureteral orifice was detected by cystoscopy in 3 cases. An externally reinforced graft was selected to form an external stent around the LRV to relieve the compression. Results The mean operation time was 67 min (65-70min). No complications occurred during surgery. The postoperative follow-up was 9 to 39 months (mean 28). Total relief was achieved in 4 men without a relapse of symptoms and abnormalities were not found in urine tests. There was partial relief for the female patient due to microscopic hematuria after the operation. In all the 5 cases, Color Doppler ultrasonography showed that the blood outflow was smooth, the inner diameter and flow velocity of the aortomesenteric portion of the LRV were both decreased, and the gonadal vein varices had diminished in diameter. Conclusions The laparoscopic extravgscular stent of the renal vein could be a feasible approach for re-establishing free renal venous outflow in patients with nutcracker syndrome. This slightly invasive treatment could eliminate the symptoms of the condition.     

肾部分切除术后术肾功能影响因素37例分析

目的探讨肾部分切除术后术肾功能的主要影响因素。方法回顾性分析2007年10月~2009年7月37例肾癌患者行开放肾部分切除术的临床资料。其中3例为双侧肾癌患者。采用99 mTc-DTPA肾核素扫描评估术前及术后3月术侧肾的肾小球滤过率（GFR）。术中所有患者行单独肾动脉阻断。统计学分析应用t检验和多变量回归分析。结果手术时间80~195min,平均（122.51±25.86）min。肾动脉阻断时间（24.51±8.05）min。肿瘤大小（3.62±0.76）cm。术前及术后3月术肾GFR分别是（47.19±6.85）、（30.40±8.87）mL/min。术侧肾术后GFR下降（16.79±6.35）mL/min,与术前相比下降约34%。经随访3~21月,无复发及转移病例。患者全部无瘤生存。多元回归分析显示,年龄（P=0.004）、术前术肾GFR（P=0.000）及肾动脉阻断时间（P=0.000）对术肾功能的影响有统计学意义。结论年龄、术前术肾肾小球滤过率及肾动脉阻断时间是影响术后肾功能的主要因素。     

保留肾单位手术后肾功能预后的影响因素分析

目的:探讨肾肿瘤行保留肾单位手术(NSS)后肾功能预后的影响因素。方法:回顾性分析西京医院2016年12月至2018年12月行NSS治疗的115例肾肿瘤患者的临床资料。男75例,女40例。年龄(49.50±12.94)岁;体质指数(24.59±3.59)kg/m 2;肿瘤最大径(3.66±1.32)cm;R.E.N.A.L.评分(6.43±1.60)分。术前患肾肾小球滤过率(GFR)(48.22±11.48)ml/(min·1.73m 2),健肾GFR(49.73±11.96)ml/(min·1.73m 2),总GFR(97.95±21.32)ml/(min·1.73m 2)。术前患肾有功能肾组织体积(FPV)(132.23±9.11)cm 3。61例行腹腔镜肾部分切除术,54例行机器人辅助腹腔镜肾部分切除术。记录手术时间、热缺血时间(WIT)、术后病理结果。记录术后6个月的血肌酐、患肾GFR、健肾GFR、总GFR、GFR保存率(术后GFR与术前GFR的比值)、患肾FPV、患肾FPV保存率(术后患肾FPV与术前FPV的比值)。患肾FPV通过手术前后的CT影像使用椭球体近似法测量。手术前后GFR和患肾FPV比较采用配对样本t检验。采用Spearman秩相关分析评估各研究因素与患肾GFR保存率间的相关性。多因素分析采用多元线性回归模型分析患肾功能的独立预测因素。以WIT=25 min为截断点将患者分为≤25 min组和>25 min组,比较两组术前患肾GFR,以及术后6个月的患肾GFR和患肾GFR保存率。结果:本组115例手术均顺利完成,中位手术时间135(75~245)min,WIT(24.57±5.51)min。患肾术后GFR(35.50±7.81)ml/(min·1.73 m 2),与术前比较差异有统计学意义(P<0.001),患肾GFR保存率为(74.65±11.10)%。术后6个月患肾FPV保存率为(84.28±4.37)%,与术前比较明显减少(P<0.001)。患肾FPV保存率与患肾GFR保存率呈极强正相关(r=0.802);WIT与患肾GFR保存率呈中等程度负相关(r=-0.503)。多元线性回归分析结果显示,术前患肾GFR(b=-0.150,P=0.008)、WIT(b=-0.443,P<0.001)、患肾FPV保存率(b=1.638,P<0.001)是患肾GFR保存率的独立预测因素。WIT>25 min组和≤25 min组的患肾GFR保存率分别为(68.77±10.88)%和(79.34±8.88)%,差异有统计学意义(P<0.001)。结论:在WIT较短(<30 min)的情况下,正常肾组织数量的保留是影响NSS术后肾功能预后的重要因素,有限的WIT起次要作用。在保证肿瘤完整切除的前提下,应尽可能保留更多的正常肾组织,同时尽量将WIT控制在25 min以内。     

肾动脉阻断对腹腔镜下保留肾单位术后肾功能的影响

目的：探讨阻断肾动脉主干对腹腔镜下保留肾单位术后患者肾功能的影响.方法回顾分析因肾肿瘤行腹腔镜下保留肾单位手术患者的临床资料,根据术中肾动脉阻断时间、出血量、肿瘤分期、肿瘤病理、术后随访及肾小球滤过率变化,分析肾动脉阻断对保留肾单位手术后肾功能的影响.结果82例患者中,肾透明细胞癌75例,乳头状肾细胞癌3例,嫌色细胞癌4例;肾动脉阻断时间平均(24．5±8．6)min,术中失血量(249．4±66．9)ml.热缺血时间在25 min 以内的患者与26~30 min 患者比较,术后患肾肾功能受损差异无统计学意义(P ＞0．05);热缺血时间为31~40 min 的患者与前两组比较,术后患肾肾功能受损差异有统计学意义(P ＜0．05).结论保留肾单位手术均会使患侧肾功能下降,但阻断肾动脉主干热缺血时间控制在30 min 内对肾功能影响相对较小.     

Serum markers are not reliable measures of renal function in conjunction with cardiopulmonary bypass

The present study explored the influence of haemodilution on estimates of the glomerular filtration rate (GFR) in conjunction with cardiopulmonary bypass (CPB) and cardiac surgery. Ninety-eight patients (n = 98) undergoing coronary artery bypass grafting with the aid of CPB were examined. The serum concentration of cystatin C and creatinine was analysed prior to surgery, after completion of CPB and in the intensive care the day after surgery. The estimated GFR was calculated using standard equations based on the serum concentration of cystatin C and creatinine. It was found that haemodilution induced by CPB had significant effects on the estimated GFR. For cystatin C, the GFR increased by 50.5 ± 2.5 ml/min (P = 0.000) and for creatinine based GFR with 22.5 ± 0.9 ml/min (P = 0.000) using the 4-variable modification of diet renal disease formula and with 22.1 ± 0.93 ml/min (P = 0.000) for the Cockcroft-Gault formula, respectively. Similar effects of haemodilution on GFR were also detected postoperatively. Haemodilution induced by CPB may therefore significantly overestimate the renal function as indicated by GFR based on serum markers.     

帕瑞昔布钠不同给药时机对胸科手术病人术后镇痛效果的影响

目的 探讨帕瑞昔布钠不同给药时机对胸科手术病人术后镇痛效果的影响.方法 采用前瞻性、随机、对照、双盲的研究方法.择期肺叶切除手术病人60例,采用随机数字表法,将病人随机分为3组(n=20),A组切皮前30 min和术毕前30 min静脉注射生理盐水2 ml;B组切皮前30 min静脉注射帕瑞昔布钠40 mg,术毕前30 min静脉注射生理盐水2 ml;C组切皮前30 min静脉注射生理盐水2 ml,术毕前30 min静脉注射帕瑞昔布钠40 mg.3组术后48 h内均行吗啡PCIA,维持VAS评分≤3分.术后随访,记录吗啡用量、病人镇痛满意度评分、体温、胸腔引流量及肝、肾和凝血功能情况,记录恶心、呕吐的发生情况.结果 与A组比较,B组和C组吗啡用量减少,病人镇痛满意度评分升高,体温降低(P＜0.05或0.01),B组与C组吗啡用量,镇痛满意度评分和体温比较差异无统计学意义(P＞0.05).3组间凝血功能指标、肝肾功能指标、胸腔引流量和恶心呕吐发生率比较差异无统计学意义(P＞0.05).结论 切皮前30 min与术毕前30 min静脉注射帕瑞昔布钠40 mg辅助术后镇痛效果相似,均可有效增强胸科手术病人术后吗啡镇痛效果,减少术后发热的发生.

Abstract：

Objective To investigate the effect of different time administration of parecoxib sodium on the postoperative analgesic efficacy in patients undergoing thoracic surgery. Methods This was a prospective,randomized, double-blind, placebo-controlled study. Sixty ASA Ⅰ orⅡ patients aged 17-83 yr undergoing pulmonary lobectomy were randomly allocated to one of 3 groups (n=20 each):A, B and C groups. Group A received normal saline 2 ml at 30 min before skin incision and the end of operation. Group B received iv parecoxib sodium 40 mg at 30 min before skin incision and normal saline 2 ml at 30 min before the end of operation. Group C received normal saline 2 ml at 30 min before skin incision and iv parecoxib sodium 40 mg at 30 min before the end of operation. All the patients received patient-controlled intravenous analgesia with morphine and VAS score was maintained≤3. The patients were followed up after operation.The morphine consumption, patients' global evaluation of the postoperative analgesia (0-100, 0=worst pain, 100=no pain), nausea and vomiting, body temperature , volume o chest drainage, hepatic, renal and blood coagulation function were recorded. Results Compared with group A, the morphine consumption was significantly reduced, the patient' s satisfaction score increased and body temperature decreased in B and C groups(P＜0.05 or 0.01). There was no significant difference in the morphine consumption, patient's satisfaction score and body temperature between B and C groups(P＞0.05). No significant difference was found in the parameters of hepatic, renal and blood coagulation function, volume of chest drainage and incidence of nausea and vomiting among the three groups(P＞0.05).Conclusion When postoperative analgesia is assisted with iv parecoxib sodium 40 mg given at 30 min before skin incision or at 30 min beforethe end of operation,the efficacy is similar,and both can improve the postoperative analgesic efficacy of morphine and reduce fever after operation in patients undergoing thoracic surgery.     

活体肾移植供肾肾小球滤过率对受体早期肾功能的影响

目的 探讨活体肾移植供肾肾小球滤过率( GFR)对受体早期肾功能的影响.方法 2006年至2011年在本中心接受活体肾移植172例为研究对象,其中亲属供肾166例(96.5％),夫妻供肾5例(2.9％),帮扶供肾1例(0.6％).术前应用放射性核素99mTC-DTPA肾动态显像测定供体左右肾GFR.供体的双肾GFR为62～148 ml/min,将对象分为供肾GFR≤45ml/min受体76例和供肾GFR＞45 ml/min 96例.两组受体的透析情况、冷、热缺血时间、抗体诱导及免疫抑制方案、HLA错配率等基本资料相似.评价患者术后早期肾功能变化情况.结果 两组患者术后急性排斥反应以及肾功能延迟恢复( DGF)发生率差异无统计学意义.与供肾GFR≤45 ml/min组比较,供肾GFR＞45 ml/min组的Scr在术后1周、1个月、3个月、1年均较低,其中术后1周的差异有统计学意义(P＜0.05);术后1个月、3个月、1年的差异均无统计学意义.重复测量的方差分析显示术后1年内两组受体Scr变化差异无统计学意义.结论 活体肾移植供肾GFR高低对受体术后1周Scr下降水平有影响,供肾GFR高者受体术后1周Scr水平低,但是对受体术后早期(1年内)的Scr整体水平及变化趋势无显著影响.     

腹腔镜下冷冻消融与肾部分切除术治疗肾细胞癌的临床效果比较

目的 比较腹腔镜下冷冻消融(laparoscopic cryoablation,LCA)和腹腔镜下肾部分切除术(laparoscopie partial nephrectomy,LPN)治疗肾细胞癌(renal cell carcinoma,RCC)的临床疗效.方法 2005年4月至2009年3月先后采用LCA和LPN治疗RCC 47例.LCA组18例患者,男性14例,女性4例,平均63岁,19例肾癌,左侧6例,右侧11例,双侧1例.肿瘤最大径1.5～5.0 cm,平均2.9 cm.LPN组29例患者,男性19例,女性10例,平均61岁.肿瘤最大径2.0～4.5 cm,平均2.8 cm.对两组患者手术前后血红蛋白(Hb)、红细胞沉降率(ESR)、血肌酐(SCr)、患侧肾小球滤过率(GFR)及两种术式手术时间、术中平均出血量、术后住院天数、术后并发症发牛率等进行统计分析.结果 48例次手术均获成功,无中转开放.LCA组和LPN组Hb、ESR、SCr、患肾GFR较术前均无明显变化(P＞0.05).两组手术时间分别为(94±29)min和(146±45)min,术中出血量分别为(37±20)ml和(274±69)ml,术后住院天数分别为(4±2)d和(10±2)d,组间比较差异均有统计学意义(P＜0.01).LCA组术后尤明显腹腔镜相关并发症,术后第1、3和6个月分别查MRI,肾脏肿瘤冷冻区域呈梗死、无信号增强、逐渐消散等演变过程;LPN组术后出现漏尿1例,2周后自行愈合.LCA组随访6～21个月,平均16个月,均未发现局部复发或远处转移.LPN组术后随访3～36个月,平均27个月,均未见肿瘤局部复发及转移.结论 LCA治疗RCC安全有效,在手术时间、术中出血量和术后恢复等方面优于LPN.     

右美托咪定持续输注对小儿全麻术后躁动的影响

目的探讨在小儿全麻手术中使用右美托咪定（dexmedetomidine,Dex）持续输注对术后躁动的影响。方法选取美国麻醉医师协会（ASA）分级Ⅰ-Ⅱ级、72名4岁．10岁在全麻下行骨折切开复位内固定手术的患儿,采用完全随机分组法随机分为4组（每组18例）,分别采用丙泊酚复合Dex（0．5μg·kg-1·h-1）（PD组）及七氟醚复合Dex（SD组）,丙泊酚复合生理盐水（PN组）及七氟醚复合生理盐水（SN组）。分别记录患儿泵注Dex前（T1）、泵注后10（T2）、20（T3）、30min（T4）及拔管时（L）的心率（heartrate,HR）、平均动脉压（mean artery pressure,MAP）、脑电双频指数（bispectralindex,BIS）;测定停止麻醉药物至拔管时间、睁眼时间;对术后患儿躁动及疼痛程度进行评分;计算患儿苏醒期躁动的发生率。结果①PD组与PN组比较、SD组与SN组比较,拔管时间[（7．1±2．6）min vs（4．4±2．1）min、（7．3±2．1）minvs（4．9±2．0）mini及睁眼时间[（16±6）minvs（10±3）min、（13±6）min vs（9±5）min]显著延长（P〈O．05）,但PD组与SD组比较差异无统计学意义（P〉0．05）。②PD组与PN组、SD组与SN组比较,术后躁动评分（1分vs2分、3分vs4分）及术后患儿疼痛程度评分（cHIPPS评分）（2_5分VS3分、4分vs7分）下降（P〈0．01）。SD组术后躁动发生率显著下降[SD组（5．6％）vsSN组（33．3％）]（P〈0．05）。PD组的躁动评分低于sD组（P〈0．05）。结论Dex虽会造成术后苏醒时间延长,但可以降低小儿麻醉术后躁动评分及术后即刻疼痛评分,并且显著降低七氟醚麻醉术后躁动发生率,使患儿苏醒期更加平稳。     

腹腔镜与开腹胃癌根治术治疗早期胃癌的临床对照研究

目的 探讨腹腔镜胃癌根治术在早期胃癌治疗中的临床应用.方法 回顾性分析2004年10月至2009年12月间分别接受腹腔镜胃癌根治术（LAP组）及开腹胃癌根治术（OPEN组）的204例早期胃癌患者的临床资料.LAP组78例,OPEN组126例;比较两组患者手术方式、手术时间、术中失血量、术后肛门排气时间、术后住院天数、并发症、术后病理和随访结果.结果 手术时间LAP组为（202.9±45.6）min,显著低于OPEN组的（219.8±45.2）min（P＜0.05）;术中失血量LAP组为（144.5±146.5）ml,显著低于OPEN组的（245.0±146.4）ml（P＜0.05）.术后第1次肛门排气时间LAP组为（3.1±1.1）d,OPEN组为（4.5±1.6）d（P＜0.05）;术后第1次进食时间LAP组为（5.2±1.9）d,OPEN组为（7.0±3.6）d（P＜0.05）;术后住院天数LAP组为（10.8±1.2）d,OPEN组为（12.4±3.8）d（P＜0.05）.术后短期并发症发生率LAP组10.3%,OPEN组12.7%（P＞0.05）.手术上、下切缘距离肿瘤为LAP组为（4.0±1.9）cm和（3.6±1.7）cm,OPEN组则为（4.2±1.7）cm和（3.5±1.8）cm（p＞0.05）,差异无统计学意义.手术平均清扫淋巴结数LAP组为（13.1±6.5）枚,OPEN组则为（14.5±8.2）枚（P＞0.05）,差异也无统计学意义.术后LAP组中位随访22（2～64）个月,无肿瘤复发和远处转移;OPEN组中位随访24（3～65）个月,1例死于肿瘤腹膜转移.两组患者住院期间的总费用比较,差异无统计学意义（P＞0.05）.结论 腹腔镜胃癌根治术是治疔早期胃癌安全、可行、微创、有效的手术方法.     

Periarterial papaverine improves early postoperative renal function after retroperitoneoscopic partial nephrectomy

Objective

To study the impact of periarterial papaverine application on the postoperative glomerular filtration rate (GFR) after retroperitoneoscopic partial nephrectomy (PN).

Materials and methods

A consecutive series of patients underwent retroperitoneoscopic PN with intraoperative, periarterial application of 50 mg of papaverine. These patients were compared with a group of patients who underwent retroperitoneoscopic PN at this institution prior to this protocol. Patients were matched for preoperative GFR, tumor size, ischemia time, and operative time.

Results

In total, 37 patients who received periarterial papaverine (P) and 37 patients without periarterial papaverine, who served as controls (C), were included in this analysis and matched according to preoperative GFR (P: 98.2, C: 97.8 ml/min/1.72 m²), tumor size (P: 2.5 cm, C: 2.5 cm), ischemia time (P: 22 min, C: 23 min), and operative time (P: 86 min, C: 85 min). Postoperative GFR was 86.4 ml/min/1.72 m² in controls (C) and 91.8 ml/min/1.72 m² in the papaverine group. The pre- to postoperative decrease in GFR was reduced by 56.9% in the papaverine group compared with controls (relative decrease in GFR: P: 5.3% vs. C: 12.5%; P = 0.02). Intra- and postoperative complications were pneumothorax (P: n = 2, C: n = 3), urinary fistula (P: n = 0, C: n = 2), and one suture-fixed drainage (P: n = 1, C: n = 0). No papaverine-related side effects were observed, and the surgical procedure was not hampered by the periarterial application of papaverine.

Conclusion

As with laparoscopic donor nephrectomy, periarterial papaverine seems to improve postoperative renal function after retroperitoneoscopic partial nephrectomy. This nephroprotective effect might be particularly advantageous for patients with an impaired renal function preoperatively.