高选择性肾动脉分支阻断术在腹腔镜肾部分切除术中的临床疗效

目的:初步探讨高选择性肾动脉分支阻断术在腹腔镜肾部分切除术(laparoscopic partial nephrectomy,LPN)中的临床疗效。方法:将2012年6月至2012年12月收治的57例肾脏肿瘤患者随机分为高选组(n=13例)与常规组(n=44),肾脏肿瘤为T1a、T1b期,且对侧肾脏功能正常。对比两组患者术中、术后及随访情况。计量资料采用t检验,方差不齐采用t'检验;计数资料采用Fisher确切概率法进行分析。结果:两组手术均获成功。高选组与常规组术中出血量、肾脏热缺血时间分别为(192.0±56.1)ml、(107.0±32.8)ml与(25.1±2.3)min、(22.4±2.9)min,两组差异有统计学意义(t=6.8889、3.0765,P<0.05);术后第1天血肌酐分别为(80.6±7.5)μmol/L、(86.3±7.8)μmol/L,差异有统计学意义(t=2.3342,P<0.05);术后3个月患侧肾小球滤过率(glomerular filtration rate,GFR)、患侧肾脏GFR下降百分比分别为(37.5±4.2)ml/min、(32.6±4.5)ml/min与(14.7±3.8)%、(23.6±4.0)%,两组相比差异有统计学意义(t=3.4990、7.1246,P<0.05);患者切缘均为阴性;手术时间、术后住院时间、肾周引流管放置时间、术后并发症发生率差异无统计学意义(P>0.05);术后随访1年以上,均未见肿瘤复发。结论:高选择性肾动脉分支阻断术在肾部分切除术中是安全、可行的,增加了肾脏热缺血时间,在肾脏功能的恢复与代谢方面具有优势,但由于数量少,期待更多高质量的试验提供高质量的证据。

The clinical effect of highly selective clamping of renal arterial branches in laparoscopic partial nephrectomy

Objective： To evaluate the clinical effect of highly selective clamping of renal arterial branches in laparoscopic partial nephrectomy. Methods： A total of 57 renal tumor patients who had been admitted to 161 st Hospital of People＇s Liberation Army from Jun. 2012 to Dec. 2012 were randomly divided into highly selective group（ n = 13） and routine group（ n = 44）. All patients had T1 aor T1btumor in one kidney and a normal contralateral kidney. Intraoperative and postoperative conditions and the results of follow-up in the2 groups were compared. All data were analyzed via t（ t＇） test or Fisher exact test. Results： All patients were operated successfully. In highly selective group and routine group,mean blood loss,warm ischemia time were（ 192. 0 ± 56. 1 vs. 107. 0 ± 32. 8） ml,（ 25. 1 ± 2. 3vs. 22. 4 ± 2. 9） min,with significant difference between the 2 groups（ t = 6. 8889,3. 0765,P〈0. 05）; serum creatinine of the first day after operation was（ 80. 6 ± 7. 5 vs. 86. 3 ± 7. 8） μmol / L,with significant difference between the 2 groups（ t = 2. 3342,P〈0. 05）; glomerular filtration rate（ GFR） of 3 months after operation（ affected side）,GFR reduction（ affected side） were（ 37. 5 ± 4. 2 vs. 32. 6 ±4. 5） ml / min,（ 14. 7 ± 3. 8 vs. 23. 6 ± 4. 0） %,with significant difference between the 2 groups（ t = 3. 4990,7. 1246,P〈0. 05）; All patients had negative margins. Mean operative time,postoperative hospital stay,time of perirenal drainage tube removal,postoperative complication were not significantly different between the 2 groups（ P〉0. 05）; No recurrence was found during the follow-up of one year. Conclusions： The highly selective clamping of renal arterial branches in laparoscopic partial nephrectomy is safe and feasible,increases warm ischemia time,has advantages in the recovery of renal function and metabolism,but due to the small sample size of included trials,more well-designed randomized controlled trails should be performed.