腹腔镜肾脏低温下行保留肾单位手术的临床研究

The clinical research of retroperitoneal laparoscopic nephron sparing surgery with hypothermic renal artery perfusion in situ

目的 探索安全有效、简单易行的后腹腔镜下肾脏低温保护技术.方法 拟行后腹腔镜下保留肾单位手术患者22例,分为研究组和对照组.研究组在后腹腔镜肾脏低温下行保留肾单位手术;对照组行常规后腹腔镜下保留肾单位手术.比较两组患者肾脏温度和直肠温度变化以及手术前后肾功能变化.结果 22例患者手术顺利;术后无继发出血、感染及漏尿.研究组冷缺血时间为（47.2±3.8）min,平均最低肾脏温度为（17.73±0.91）℃.研究组术前ECT示患肾肾小球滤过率（GFR）为（30.57±4.07） ml/min,术后1个月患肾GFR为（20.92 ± 4.49） ml/min.对照组术前ECT示患肾GFR为（30.65±5.45） ml/min,术后1个月患肾GFR（17.90±3.50） ml/min.患者术后随访1 ～16个月,未见局部复发、无转移.结论 后腹腔镜下肾脏低温保护技术简单易行、效果确切.

Objective Development of a new retroperitoneal laparoscopic technology which can keep the kidney in cold ischemia and has the characteristics of safety,effective and simplicity.Methods Twenty two patients who needs to do the retroperitoneal laparoscopic nephron sparing suygery were divided into two groups.In research group,we did the retroperitoneal laparoscopic nephron sparing surgery with hypothermic renal artery perfusion in situ.In the control group,we did the same as well except the renal hypothermia.Compared with the renal temperature and the rectal temperature during the surgery,and the glomerular filtration rate （GFR） of both bilateral kidney and affected side kidney before and after the surgery.Results All the surgery were done successfully in the patients of both groups.And no post-operative bleeding,inflammation and leakage of urine was found.In the research group,the average Cold ischemia time was （47.2 ±3.8） min,the average minimum renal temperature was （17.73 ±0.91） ℃.In the research group,the average value of affected side kidney GFR was （30.57 ± 4.07） ml/min before the surgery ; the average value of affected side kidney GFR was （20.92 ± 4.49） ml/min 1 month after the surgery.In the control group,the average value of affected side kidney GFR was （30.65 ± 5.45） ml/min before the surgery; the average value of affected side kidney GFR was （17.90 ± 3.50） ml/min 1 month after the surgery.The follow-up time was 1-16 months without local recurrence and metastasis.Conclusion We found that our new equipment with circumfusion system of ice saline can keep the kidney in cold ischemia,it was easy-to-use and efficient.