选择性肾动脉阻断用于后腹腔镜肾癌肾部分切除术的效果

Efficacy of selective renal artery interruption during partial nephrectomy under laparoscopy for renal carcinoma

目的比较选择性肾动脉阻断与肾动脉全阻断在后腹腔镜肾癌肾部分切除术(RLPN)中的手术效果。方法回顾性分析82例行RLPN患者的资料,其中39例实施选择性肾动脉阻断(A组),43例行肾动脉全阻断(B组)。比较两组手术相关资料和并发症发生情况。结果两组手术均获成功,切缘病理检查均为阴性。两组患者术中肾动脉阻断时间、出血量、住院时间和并发症发生率均无统计学差异(P>0.05)。与B组比较,A组手术时间长[(110.3±17.16)min vs.(86.62±45.78)min],术后血清肌酐低[(74.61±19.56)μmol/L vs.(98.65±26.82)μmol/L],患肾肾小球滤过率高[(24.84±4.86)ml/min vs.(17.68±4.67)ml/min](P<0.05)。结论与肾动脉全阻断比较,选择性阻断肾动脉能有效地保护肾功能;虽增加了手术时间,但术中出血量及手术风险并无增加。

Objective To compare the efficacy of selective and complete renal artery interruption during partial nephreetomy under retroperitoneal laparoscopy （RLPN）. Methods The data of 82 cases underwent RLPN for renal carcinoma were retrospectively analyzed. RLPN was performed under selective renal artery interruption in 39 cases （group A） or complete renal artery interruption in 42 cases （group B）. The operation-related data were compared between two groups. Results All surgeries were performed successfully and the margines of tumors were negative for tumor tissues. There were no significant differences in the time for renal artery interruption, blood loss, postoperative hospital stay and incidence of complications between two groups （P〉0. 05）. Compared to group B,the patients in group A had a longer operative time[（ll0. 3 ±17. 16） min vs. （86. 62±45.78） mini, but lower serum creatinine[（74. 61 ± 19.56） btmol/L vs. （98. 65 ± 26.82） μmol/L] ,and higher glomerular filtration rate of diseased kidney[-（30. 52d：5.45） ml/min vs. （17. 68 ±4. 67） ml/min] （P〈0. 05）. Conclusion Compared to complete renal artery interruption for RLPN, selective renal artery interruption can protect renal function, but does not increase surgical bood loss and risk although the operative time is prolonged.