肾动脉阻断对腹腔镜下保留肾单位术后肾功能的影响

The influences of renal artery occlusion on renal function of patients accepted laparoscopic nephron sparing surgery

目的探讨阻断肾动脉主干对腹腔镜下保留肾单位术后患者肾功能的影响。方法回顾分析因肾肿瘤行腹腔镜下保留肾单位手术患者的临床资料,根据术中肾动脉阻断时间、出血量、肿瘤分期、肿瘤病理、术后随访及肾小球滤过率变化,分析肾动脉阻断对保留肾单位手术后肾功能的影响。结果 82例患者中,肾透明细胞癌75例,乳头状肾细胞癌3例,嫌色细胞癌4例;肾动脉阻断时间平均（24.5±8.6）min,术中失血量（249.4±66.9）ml。热缺血时间在25 min以内的患者与26~30min患者比较,术后患肾肾功能受损差异无统计学意义（P〉0.05）;热缺血时间为31~40min的患者与前两组比较,术后患肾肾功能受损差异有统计学意义（P〈0.05）。结论保留肾单位手术均会使患侧肾功能下降,但阻断肾动脉主干热缺血时间控制在30min内对肾功能影响相对较小。

Objective To investigate influence of renal artery occlusion on renal function of patients accepted laparoscopic nephron sparing surgery. Methods Patients accepted laparoscopic partial nephrectomy at our hospital in recent years were retrospectively studied.We analyzed the influence of renal artery occlusion on renal function with the relationship of intraoperative renal artery occlusion time,blood loss,tumor stage,tumor pathology,postoperative follow-up results,and changes in GFR. Results There were 75 cases with renal cell carcinoma,3cases with papillary renal cell carcinoma,and 4cases with chromophobe cell carcinoma.The renal artery occlusion average time was（24.5±8.6）min.The intraoperative blood loss was（249.4±66.9）ml.There was no significant difference（P〉0.05）in postoperative renal dysfunction between two groups（warm ischemia time within 25 min and within 26-30min）.There was a significant difference（P〈0.05）between the former two groups and the third group（warm ischemia time was 31-40min）. Conclusions It could pretect renal function by nephron sparing surgery.If hot ischemia time is within 30 min,there is little effect on renal function.