高选择性肾动脉分支阻断与全阻断下腹腔镜保留肾单位手术疗效及肾功能对比

目的 探讨肾动脉主干阻断(main renal artery clamping,MRAC)与高选择性肾段动脉分支阻断(selective segmental renal artery clamping, SSRAC)下行腹腔镜保留肾单位手术(laparoscopic nephron sparing surgery, LNSS)的临床效果及安全性评价。方法 回顾性分析2017年10月至2018年10月收治的T1期局限性肾肿瘤患者84例,其中行SSRAC下LNSS 42例(S组),行MRAC下LNSS 42例(M组)。比较2种手术方法的手术时间、术中失血量、术中热缺血时间、术后住院时间、切缘阳性率;术前术后SCr、BUN;术中、术后并发症发生率等。结果 所有手术顺利完成,无手术切缘阳性者,无术中中转为MRAC者。S组手术时间、术中失血量较M组增加,差异有统计学意义(P<0.05),2组术中热缺血时间、术后引流量、术后住院时间等差异无统计学意义(P>0.05);2组术前SCr、BUN水平差异无统计学意义(P>0.05),术后1 d血SCr、BUN水平较术前显著升高,S组术后1 d SCr、BUN显著低于M组(P<0.05);2组患者术中术后并发症发生率差异无统计学意义(P>0.05)。结论 SSRAC是新的肾动脉阻断技术,应用于LNSS患者治疗效果显著、安全性高,且对肾脏功能影响小,本研究尚需要大样本数据支持。

Contrastive study of the effect and renal function of selective segmental renal artery clamping and main renal artery clamping in laparoscopic retroperitoneal partial nephrectomy

Objective To investigate the clinical efficacy and safety of laparoscopic nephron sparing surgery(LNSS)with the two different methods, main renal artery clamping(MRAC)and selective segmental renal artery clamping(SSRAC). Methods 84 patients, who had the localized renal tumor in stage T1, admitted from October 2017 to October 2018 were conducted a retrospective analysis,42 of the patients were operated with the method of SSRAC(Group S), and the other 42 patients were operated with the method of MRAC(Group M). The operative time, intraoperative blood loss, intraoperative warm ischemia time, postoperative hospital stay, positive margins, the values of serum creatinine rate(SCr)and blood urea nitrogen(BUN)before and after surgery, intraoperative and postoperative complications rate and so on were compared between the two surgical methods. Results All the operations were successfully completed, and there was no positive margins. There was no intraoperative transfer to MRAC in group S. There was no significant difference in the operation time and intraoperative blood loss between the Group S and the Group M(P<0.05). There was no significant difference in the duration of warm ischemia, postoperative drainage, and postoperative hospital stay(P>0.05). There was no significant difference in preoperative SCr and BUN levels between the two groups(P>0.05). The levels of SCr and BUN in the 1st day of postoperative period were significantly higher than those before surgery. There was significant difference in SCr and BUN between the 1st day after operations in the Group S(P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05). Conclusion SSRAC is a new renal artery occlusion technique. It is effective and safe in patients with LNSS, and its effect on renal function is small. This study still needs to be supported with large amounts of sample cases.