低R.E.N.A.L评分肾肿瘤行腹腔镜肾部分切除术中肾动脉无阻断的有效性和安全性分析

Renal artery clamping versus non-clamping laparoscopic partial nephrectomy for renal mass of low R.E.N.A.L score

目的：比较肾动脉阻断与不阻断下行腹腔镜肾部分切除术对于治疗低R.E.N.A.L评分肾肿瘤的有效性和安全性。方法：回顾性分析2013年6月~2014年3月我院同一名医师完成的腹腔镜肾部分切除术73例临床资料,R.E.N.A.L评分均≤6,其中肾动脉阻断组54例,肾动脉无阻断组19例。比较两组患者一般资料、围手术期及手术前后肾功能变化等指标。结果：手术均顺利完成,无中转开放。阻断组术中肾动脉阻断时间为（18.5±8.5）min。阻断组较无阻断组手术时间长（130.1±20.5vs.104.2±13.6min）、术中失血少（153.3±56.6vs.223.4±92.7ml）,差异均有统计学意义（P〈0.05）。两组间输血率、切缘阳性率、术后并发症发生率及术后住院时间差异无统计学意义（P〉0.05）。两组间术后1周血肌酐变化值的差异无统计学意义（15.3±4.1vs.14.3±4.2μmol·L-1,P〉0.05）,术后1个月阻断组患肾GFR较后者差（40.1±5.6vs.44.2±7.2ml·min-1）,差异有统计学意义（P〈0.05）,两组间术后1年患肾GFR的差异无统计学意义（46.5±5.7vs.47.0±7.1ml·min-1,P〉0.05）。术后随访16个月,无复发病例。结论：对于R.E.N.A.L评分≤6分肾肿瘤行腹腔镜肾部分切除术,阻断肾动脉可减少术中出血且不增加切缘阳性率。阻断和无阻断肾动脉对短期肾功能的影响有差别,而对长期肾功能的影响无差别。

Objective： To compare the efficacy and safety between renal artery clamping and non-clamping laparoscopic partial nephrectomy for renal mass with low R. E, N. A. L score. Method： A retrospective analysis of a consecutive series of 73 patients with renal mass of low R. E. N. A. L score who underwent laparoscopic partial ne- phrectomy by a same urologist from Jun. 2013 to Mar. 2014 was performed. Fifty-four patients underwent surgeries with renal artery clamping, and 19 patients underwent surgeries without renal artery clamping. Patients de- mographics, tumour characteristics, perioperative outcomes and renal function before and after operation were compared. Result.. All operations were performed successfully without conversion. The median clamping time was （18.5±8.5） rain in clamped group. In clamped group, operation time was longer than that in unclamped group （130.1±20.5 vs. 104.2±13.6 rain, P 〈0.05）, and blood loss was less than that in undamped group （153.3± 56.6 vs. 223.4±92.7 ml, P 〉0.05）. Blood transfusion rate, positive surgical margins, postoperative complications and postoperative hospital stay were similar between two groups （ P 〉0.05）. The difference of the change of serum ereatinine were not significant between two groups （15.3±4.1 vs. 14.3±4.2 μmol . L-1 , P 〉0.05）. In clamped group, the GFR one month postoperatively was poorer than that in unclamped group （40.1 ±5.6 vs. 44.2±7.2 ml .min-1 , P 〈0.05）. GFR one year postoperatively were similar between two groups （46.5±5.7 vs. 47.0±7.1 ml . min-1, P 〉0.05）. Median follow-up was sixteen months and no recurrence occurred. Conclu- sion： Renal artery clamping laparoscopic partial nephrectomy for renal masses with low R. E. N. A. L score has less blood loss without increasing positive surgical margin. that in clamped group, but the difference of long-term Short-term renal function in unclamped group is better than renal function isn＇t significant between two groups.