选择性肾动脉阻断与全阻断行后腹腔镜肾部分切除术的对照研究

目的:对比分析选择性肾动脉阻断及肾动脉全阻断后腹腔镜肾部分切除术(retroperitoneal laparoscopic partial ne-phrectomy,RLPN)治疗肾癌的有效性及安全性。方法:回顾分析2008年1月至2011年5月79例患者行RLPN的临床资料(肿瘤直径≤4 cm)。79例患者分为选择性肾动脉阻断组(42例)和肾动脉全阻断组(37例),对比两组患者肾动脉阻断时间、手术时间、术中出血量、术中输血率、术后并发症、住院时间及生存随访情况等。结果:两组肾动脉阻断时间、手术时间差异有统计学意义(P<0.05);术后住院时间、术中出血量和术中输血率差异无统计学意义(P>0.05);术后并发症发生率分别为2.4%(1/42)及2.7%(1/37),两组差异无统计学意义(P>0.05)。术后随访6～48个月,无一例复发或转移。结论:对于较小的肾癌,选择性肾动脉阻断术的动脉阻断时间可适当延长,虽然手术时间延长,但出血量未明显增加,利于保护正常区域肾单位,术后肾功能恢复更好。

Comparison of selectivity renal artery interrupted and renal artery interrupted retroperitoneal laparoscopic partial nephrectomy on small renal carcinoma

Objective:To compare the efficacy and safety on renal carcinoma with selectivity renal artery interrupted and renal artery interrupted retroperitoneal laparoscopic partial nephrectomy(RLPN).Methods:The data of 79 patients with renal carcinoma who underwent retroperitoneal laparoscopic partial nephrectomy from Feb.2008 to May 2011 in our hospital was analyzed retrospectively.The tumor diameter was within 4cm.The patients aged from 25 to 72 were divided into 2 groups:selectivity renal artery interrupted group with 42 cases and renal artery interrupted group with 37 cases.The differences of renal pedical clamping time,operation time,blood loss,postoperative hospital stay and the incidence of complications between the two groups were compared and analyzed.Results:The renal pedical clamping time,operation time of selectivity renal artery interrupted and renal artery interrupted group were(22.80±4.58) min and(28.12±4.31) min,(110.25±14.76) min and(96.10±15.40) min respectively.There was statistical significance between the two groups.The hospital stay,blood loss and intraoperative blood transfusion rate of selectivity renal artery interrupted and renal artery interrupted group were(8.80±1.51) d and(9.02±1.69) d,(107.0±73.99) ml and(130.20±89.51) ml,2.4%(1/42) and 2.7%(1/37).There was no significant difference between them(P>0.05).The rates of postoperative complication in selectivity renal artery interrupted and renal artery interrupted group were 2.4%(1/42) and 2.7%(1/37),there was no significant difference between them(P>0.05).The follow-up of the two groups was 6-48 months without recurrence and metastasis.Conclusions:As for small kidney cancer,selectivity renal artery interrupted operation has the advantage of extended renal pedical clamping time which will help to protect normal nephrons,the recovery of renal function is better.It has longer operation time due to operating conditions and technology,but bleeding was not significantly increased.Selectivity renal artery interrupted retroperitoneal laparoscopic partial nephrectomy is worthy of promotion for qualified hospital.