超选择性肾动脉栓塞联合经腹腹腔镜肾部分切除术在老年T1b期肾癌中的应用

目的:探讨DSA超选择性肾动脉栓塞联合经腹腹腔镜肾部分切除术治疗老年T1b期肾癌的安全性及可行性。方法:选择2016年1月至2018年1月于辽宁省肿瘤医院因罹患T1b期肾癌而行肾部分切除术的22例老年患者，进行回顾性研究。术前1~12 h先在介入手术室行DSA超选择性肾肿瘤靶动脉栓塞，然后再行经腹腹腔镜下零缺血肾部分切除术。对于术中手术时间、术中出血量、输血情况、术后胃肠道功能恢复所需时间、术后引流管拔除时间、术后并发症、术后住院时间、术后组织病理学指标等进行统计分析，并且术后进行随访统计肿瘤的复发和转移情况。结果:所有手术均成功完成，无中转改开放病例，无死亡病例，仅1例因肿瘤切除过程中出血较多，采用动脉夹暂时阻断肾动脉主干，阻断时间约为14 min。术中手术时间为（152.22±7.34） min，术中出血量为（102.27±66.82） ml，术后胃肠道功能恢复时间为（1.45±0.60） d，腹腔引流管拔除时间为（2.91±0.75） d，术后住院时间为（6.27±1.12） d，术后并发症发生率为9.09%，术中和术后输血率分别为4.54%和4.54%。所有患者均术后随访12~36个月，暂未发现肿瘤复发与转移。结论:超选择性肾动脉栓塞联合经腹腹腔镜肾部分切除术治疗老年T1b期肾癌安全、可行。

Application of superselective renal artery embolization combined with transabdominal laparoscopic partial nephrectomy in elderly patients with T1b renal cell carcinoma

Objective:To investigate the safety and feasibility of DSA superselective renal artery embolization combined with transabdominal laparoscopic partial nephrectomy in the treatment of T1b renal cell carcinoma in the elderly.Methods:From January 2016 to January 2018，22 elderly patients undergoing partial nephrectomy for T1b renal cell carcinoma in Liaoning Cancer Hospital were studied retrospectively.DSA superselective target artery embolization was performed in the interventional operating room 1~12 hours before laparoscopic partial nephrectomy with zero ischemia.The operative time，intraoperative blood loss，blood transfusion，postoperative gastrointestinal function recovery time，postoperative drainage tube removal time，postoperative complications，postoperative hospital stay and postoperative histopathological indexes were statistically analyzed.The recurrence and metastasis of the tumor were followed up after operation.Results:All the operations were completed successfully.There were no cases of conversion to opening and no death.Only one case had more bleeding during tumor resection.The main renal artery was temporarily blocked with clips for about 14 minutes.The intraoperative operation time was (152.22±7.34) min.The intraoperative blood loss was (102.27±66.82) ml，and the recovery time of gastrointestinal function was (1.45±0.60) days.The removal time of abdominal drainage tube was (2.91±0.75) days and the postoperative hospital stay was (6.27±1.12) days.The incidence of postoperative complications was 9.09%.The intraoperative and postoperative blood transfusion rates were 4.54% and 4.54% respectively.All patients were followed up for 12 months and 36 months.No tumor recurrence and metastasis were found.Conclusion:Superselective renal artery embolization combined with transabdominal laparoscopic partial nephrectomy is safe and feasible in the treatment of T1b renal cell carcinoma in the elderly.