半程肾动脉阻断在腹腔镜肾部分切除术中的应用

目的探讨半程肾动脉阻断技术在腹腔镜肾部分切除术（laparoscopy partial nephrectomy，LPN）中的安全性及对残肾功能的保护作用。方法回顾性分析行LPN的T1期肾脏肿瘤病人共94例。根据肾动脉阻断时程不同分为半程肾动脉阻断组（A组）32例和全程肾动脉阻断组（B组）62例。根据肿瘤分期不同，A组分为T1a期病人（A1组）21例和T1b期病人（A2）11例；B组分为T1a期病人（B1组）43例和T1b期病人（B2组）19例。分析病人手术时间、出血量、热缺血时间（warm ischemia time，WIT）、血尿、漏尿等围手术期指标和肾萎缩、肾功能下降等远期并发症等指标。结果94例病人均手术顺利。A组病人WIT明显短于B组病人，eGFR下降值低于B组（P < 0.01）；病人WIT A1组短于B1组、A2组短于B2组（P < 0.01）。但在手术时间、术中出血量、血尿、漏尿、肾萎缩等指标差异无统计学意义（P>0.05）。结论半程肾动脉阻断技术可减少T1期肿瘤LPN中肾脏WIT，减少肾功能下降，尤其对T1b期肿瘤优势更为显著。该技术具有良好的安全性与实用性，值得临床推广。

Appliance value of half-course renal artery blocking in laparoscopy partial nephrectomy

ObjectiveTo investigate the safety and protective effect on renal function of half-course renal artery blocking in laparoscopy partial nephrectomy(LPN).MethodsThe clinical data of 94 stage T1 renal cancer patients treated with LPN were retrospectively analyzed.The patients were divided into the half-course renal artery blocking group(group A, 32 cases))and whole-course renal artery blocking group(group B, 62 cases)according to the blocking course of renal artery.According to the tumor staging, the group A was subdivided into the stage T1a group(group A1, 21 cases)and stage T1b group(group A2, 11 cases), and the group B was subdivided into the stage T1a group(group B1, 43 cases)and stage T1b group(group B2, 19 cases).The operation time(OT), bleeding volume(BV), warm ischemia time(WIT), hematuria and urine leakage of perioperative indicators, and renal atrophy and renal function loss of long-term complications parameters in group A and group B were analyzed.ResultsThe operations in all patients were successfully completed.The WIT in group A was significant shorter that in group B, and the decreasing value of eGFR in group A was significant lower that in group B(P < 0.01).The WIT in group A1 and group A2 were shorter those in group B1 and group B2, respectively(P < 0.01).However, there was no statistical significance in OT, BV, hematuria, urine leakage, renal function decline and renal atrophy between group A and group B(P>0.05).ConclusionsThe half-course renal artery blocking can shorten renal WIT and reduce incidence of postoperative renal atrophy, especially for patients with stage T1b renal tumor.It has good safety and practicability, and is worthy of clinical application and promotion.