零热缺血后腹腔镜肾部分切除术治疗T1a肾癌的近期临床疗效

目的探讨未阻断肾蒂血管后腹腔镜下肾部分切除术治疗T1a期肾癌的临床疗效。 方法回顾性分析2016年1月至2018年12月佛山市第一人民医院行后腹腔镜下肾部分切除术的56例（24例无肾蒂阻断，32例阻断肾蒂血管）T1a期肾癌的临床资料。 结果两组患者在术前平均血肌酐水平（无肾蒂阻断组72 μmol/L；肾蒂阻断组75 μmol/L）、平均手术时间（无肾蒂阻断组64 min；肾蒂阻断组60 min）、术后1个月平均血肌酐水平（无肾蒂阻断组75 μmol/L；肾蒂阻断组82 μmol/L）差异均无统计学意义（P>0.05）。两组患者在术中平均出血量（无肾蒂阻断组为100 ml；肾蒂阻断组为44 ml）、术中热缺血时间（无肾蒂阻断组为0 min ；肾蒂阻断组为25 min）差异均有统计学意义（P<0.05）。无肾蒂阻断组术侧放射性核素断层扫描术前平均51 ml/min，术后1个月平均49 ml/min，差异无统计学意义（P>0.05）。肾蒂阻断组术侧放射性核素断层扫描术前平均52 ml/min，术后1个月平均45 ml/min，差异有统计学意义（P<0.05）。两组肾癌患者术后病理报告均为肾透明细胞癌，术后随访3～36个月，平均17个月，肿瘤无复发转移。 结论零热缺血后腹腔镜下肾部分切除术治疗T1a肾癌安全可行，有利于术侧肾单位及功能的保留。

Recent clinical efficacy of laparoscopic partial nephrectomy without thermal ischemia for the treatment of T1a renal carcinoma

ObjectiveTo investigate the clinical efficacy of laparoscopic partial nephrectomy (LPN) for the treatment of T1a renal carcinoma without renal pedicle occlusion. MethodsThe clinical data of stage T1a renal cell carcinoma from January 2016 to December 2018 in the First People's Hospital of Foshan were retrospectively analyzed. Twenty-four patients underwent laparoscopic partial nephrectomy without renal pedicle occlusion and the renal pedicle occlusion of 32 patients in the same period. ResultsBetween no renal pedicle occlusion group and renal pedicle occlusion group, preoperative average creatinine (72 μmol/L vs 75 μmol/L), average operation time (64 min vs 60 min), postoperatively average creatinine (75 μmol/L vs 82 μmol/L) were not different significantly (P>0.05). Average intraoperative bleeding (100 ml vs 44 ml) and thermal ischemia time (0 min vs 25 min) were different significantly between two groups (P<0.05). Preoperatively ECT of surgical lateral kidney (51 ml/min vs 52 ml/min) was not different significantly between two groups, and the same between preoperative and preoperative (51 ml/min vs 49 ml/min) in no renal pedicle occlusion group (P>0.05). ECT of surgical lateral kidney was different significantly between preoperative and preoperative (52 ml/min vs 45 ml/min) in renal pedicle occlusion group (P<0.05). The postoperative pathological reports were all renal transparent cell carcinoma.All patients were followed up for 3-36 months with an average of 17 months, no recurrence and matastasis. ConclusionsLPN for the treatment of T1a renal cell carcinoma could be performed safely with good outcomes. LPN is beneficial for the preservation of renal units and functions.