超选择性肾动脉分支阻断技术在经腹腹腔镜肾部分切除术中的初步应用

Superselective clamping of renal artery in laparoscopic partial nephrectomy:primary experience sharing

目的探讨超选择性肾动脉分支阻断术在腹腔镜下肾部分切除术中的可行性、安全性及其对患者术后肾功能的短期影响。方法回顾性分析长海医院泌尿外科2013年6月至2014年5月因肾恶性肿瘤入院,并接受同一术者经腹腹腔镜肾部分切除术治疗患者的临床资料,比较超选择性肾动脉分支阻断术(10例)和肾动脉主干阻断术(13例)对手术时间、术中出血量及术后肾功能等临床参数的影响。结果与肾动脉主干阻断术相比,采用超选择分支阻断术者手术时间延长[(257.60±22.03)min vs(199.08±36.70)min,P<0.05]、术中出血量增多[(220.00±57.01)mL vs(71.54±30.51)mL,P<0.05]、术后切口平均引流量增加[(113.33±24.82)mL vs(68.08±28.88)mL,P<0.05],两组患者术后均无大出血、尿漏等严重并发症发生。但在血管阻断时间相当的条件下[(28.60±8.17)min vs(27.85±6.16)min],超选择分支阻断术对肾功能的损害小于肾动脉主干阻断术,接受分支阻断处理的患者术后早期肾小球滤过率(eGFR)的下降程度明显低于后者[(3.14±7.22)%vs(15.26±9.53)%,P<0.05]。结论超选择性分支动脉阻断术对肾功能损害低于传统的肾动脉主干阻断术,有利于腹腔镜下肾部分切除术后肾功能的早期恢复,值得进一步研究。

Objective To evaluate the feasibility and safety of superselective renal artery clamping technique in laparoscopic partial nephrectomy and to assess its short-term effect on postoperative renal function.Methods Totally 23 patients,who were diagnosed as having renal malignant tumor and treated with transperitoneal laparoscopic partial nephrectomy by the same doctor at department of urology,Changhai Hospital from June 2013 to May 2014,were included in the present study.Superselective technique and traditional renal artery clamping technique were employed in group A（10cases）and group B（13cases）,respectively.The operation time,intraoperative blood loss,postoperative renal function and other clinical parameters were compared between the two groups.Results Compared with group B,group A had significantly increased operation time（[257.60 ± 22.03]min vs[199.08 ± 36.70]min,P〈0.05）,intraoperative blood loss（[220 ± 57.01]mL vs[71.54±30.51]mL,P〈0.05）and postoperative incision drainage（[113.33±24.82]mL vs[68.08±28.88]mL,P〈0.05）,and there were no GradeⅢ-Ⅳcomplications such as massive bleeding or urinary leakage in the two groups.But patients in group A had slighter renal function damage postoperatively in the early stage compared with group B,as demonstrated by slighter eGFR decrease（[3.14 ± 7.22]% vs[15.26 ± 9.53]%,P〈0.05）for a similar ischemic time（[28.60±8.17]）min vs（[27.85±6.16]min）.Conclusion Superselective renal artery clamping does less harm to the kidney than traditional main renal artery clamping in laparoscopic partial nephrectomy,and it is worth further research for its benefit in early-stage renal function recovery postoperatively.