高选择性肾动脉阻断在后腹腔镜下保留肾单位手术中的临床价值

Evaluation of high- selective renal artery blockage in retroperitoneal laparoscopic nephron- sparing surgery

目的：比较高选择性肾动脉阻断与肾动脉全阻断在后腹腔镜下保留肾单位手术中的临床疗效、安全性及对其术侧肾功能的影响。方法：选取拟行后腹腔镜下保留肾单位肾肿瘤患者56例,分为实验组和对照组。实验组29例,后腹腔镜下高选择性肾动脉阻断后行保留肾单位手术;对照组27例,后腹腔镜下完全肾动脉阻断后行保留肾单位手术。记录两组患者手术时间、肾动脉阻断时间、术中出血量,监测术前及术后即刻、1月、3月血清总肌酐值,并进一步ECT肾动态测定总肾及分肾肾小球滤过率（GFR）。结果：56例患者手术顺利完成,两组各有2例改后腹腔镜下肾脏根治性切除术。实验组手术时间、肾动脉阻断时间较对照组明显延长（P〈0.05）,实验组与对照组术中出血量无显著差异（P〉0.05）。两组患者术前血肌酐值无显著性差异（P〉0.05）,对照组术后即刻显著升高（P〈0.05）,术后1月、术后3月有所下降,在正常值范围,但仍高于术前水平（P〈0.05）;实验组术后即刻血肌酐显著升高（P〈0.05）,术后1月、3月降至术前水平（P〉0.05）,术后各时间节点实验组肌酐值均比对照组低（P〈0.05）。对照组术后即刻总肾及术侧GFR显著降低（P〈0.05）,1月、3月有所回升,但低于术前水平（P〈0.05）;实验组术后即刻总肾及术侧GFR降低（P〈0.05）,至1月、3月升至术前水平（P〉0.05）,术后实验组各时间节点总肾GFR及术侧GFR均比对照组高（P〈0.05）。术后随访1~3年,本组未见肿瘤局部复发、无远处转移,肾功能未出现异常。结论：后腹腔镜下保留肾单位手术肾动脉高选择性阻断较肾动脉全阻断术式手术时间有所延长,但术后对肾功能影响小、恢复快。

Objective： To compare the clinical efficacy,safety and impaction on renal function between high- selective renal artery blockage and complete renal artery blockage in retroperitoneal laparoscopic nephron- sparing surgery. Methods： All 56 cases of renal tumor patients were divided into two groups： the experimental group and the control group. In the experimental group,29 patients were conducted with high- selective renal artery blockage,27 cases in the control group,were conducted with whole renal artery blockage in retroperitoneal laparoscopic nephron- sparing surgery. The operation time,artery blockage time,blood loss,and serum creatinine were recorded in two groups before and after operation. The total and unilateral glomerular filtration rate（ GFR） was determined by ECT. Results： All 56 cases were operated successfully,2 cases in each group were transferred to retroperitoneal laparoscopic radical nephrectomy. The operation time and artery blockage time of experimental group were significantly longer than the control group（ P〈0. 05） and there was no significant difference of blood loss between experimental group and control group（ P〉0. 05）. There was no significant difference of serum creatinine between the two groups preoperatively（ P〉0. 05）,serum creatinine were elevated instantly postoperatively in the control group（ P〈0. 05）,and declined 1month and 3 months postoperatively which were significantly higher than preoperation（ P〈0. 05）. In the experimental group,serum creatinine was elevated instantly postoperatively（ P〈0. 05）,there was no significant difference 1 month and 3 months postoperatively（ P〉0. 05）. In control group,GFR of the total and unilateral renal was significantly decreased instantly postoperatively（ P〈0. 05）,in 1 month and 3 months postoperatively which were significantly lower than preoperation,but lower than the preoperative level（ P〈0. 05）. In the experimental group,GFR of the total and unilateral renal was significantly decreased instantly postoperatively（ P〈0. 05）,there was no significant difference 1month and 3 months postoperatively（ P〉0. 05）. GFR of the total and unilateral renal were higher than control group.There was no tumor local recurrence and distant metastasis,renal function did not deteriorate to abnormal in 1 ~ 3years follow- up. Conclusion： The operation time of high- selective renal artery blockage was significantly longer than the complete renal artery blockage in retroperitoneal laparoscopic nephron- sparing surgery,but adopted high-selective renal artery the renal function will be influenced slightly and recovered quickly.