高选择性肾动脉阻断技术在腹腔镜下保留肾单位手术中的应用研究

目的比较腹腔镜下选择性肾段动脉分支阻断与肾动脉主干阻断行肾部分切除术的可行性和安全性,评价其手术效果。方法回顾性分析郑州大学附属洛阳中心医院在2013年10月-2017年2月收治的65例T1期肾肿瘤患者的资料,其中行高选择性肾段动脉分支阻断肾部分切除术29例,行肾动脉主干阻断肾部分切除术36例,比较两种方法的术前术后肌酐变化、术中失血量、热缺血时间、手术时间、住院时间和切缘阳性率等。结果所有手术均顺利完成,无明显手术并发症,肾动脉分支阻断组手术时间较肾动脉主干阻断组长,但其术前术后肌酐变化较肾动脉主干阻断组小。两组在术中失血量、热缺血时间和切缘阳性率等方面差异无统计学意义(P0.05);两组患者在年龄、体质指数(BMI)、肾肿瘤R.E.N.A.L评分等方面差异无统计学意义(P0.05)。结论对于T1期肾肿瘤,选择性肾动脉分支阻断技术手术时间较长,但其肾脏组织热缺血区域小,对肾脏影响小。

Application of highly selective renal artery occlusion in laparoscopic partial nephrectomy

Abstract: Objective To compare the feasibility and safety of laparoscopic partial renal segmental artery occlusion and renal artery trunk interruption for partial nephrectomy. Methods We reviewed medical records of 65 patients with stage T1 renal tumor from October 2013 to February 2017. Among them, 29 cases underwent partial nephrectomy with high selective segmental renal artery occlusion, and 36 cases underwent partial nephrectomy with renal artery trunk occlusion. Then compare the preoperative and postoperative creatinine changes, intraoperative blood loss, warm ischemia time, operation time, hospitalization time and positive margins of the two methods. Results In all the patients, the procedures were done without conversion to open surgeries. The operation time of the renal artery branch block group is shorter than that of the main renal artery block, but the preoperative and postoperative creatinine changes are smaller than those of the main renal artery occlusion group. There was no significant difference between the two groups in intraoperative blood loss, warm ischemia time and positive margins (P > 0.05); There was no significant difference between the two groups in age, body mass index (BMI) and R.E.N.A.L score of renal tumor (P > 0.05). Conclusion For the stage T1 renal tumor, the selective renal artery branch interruption technique has a longer operation time, but the renal tissue has a small ischemic zone and has little effect on the kidney.