术前选择性动脉栓塞联合腹腔镜肿瘤剜除术治疗肾错构瘤

Clinical study of preoperative selective arterial embolization combined with laparoscopic enucleation of tumor in treatment of renal hamartoma

目的 探讨肾错构瘤（RAML）采用术前选择性动脉栓塞术（SAE）与腹腔镜肿瘤剜除术治疗的临床效果。方法回顾分析2014年1月至2016年1月我院收治的52例RAML患者的临床资料,其中22例患者术前行SAE后24 h内腹腔镜肿瘤剜除术（SAE组）,30例患者未行SAE直接行腹腔镜肿瘤剜除术治疗（非SAE组）,对比2组的临床效果。结果 SAE组的肿瘤剜除术成功率为100%（22/22）,高于非SAE组的66.67%（20/30）,差异有统计学意义（P〈0.05）。SAE组的术中出血量、手术时间、肾动脉阻断时间、胃肠功能恢复时间均少于非SAE组,差异具有统计学意义（P〈0.05）,住院时间明显长于非SAE组,差异有统计学意义（P〈0.05）。术后3个月,2组e GFR比较差异无统计学意义（P〉0.05）,SAE组的Scr显著低于非SAE组,差异具有统计学意义（P〈0.05）。SAE组术后并发症率为4.55%（1/22）,与SAE组的10.00%（3/30）,差异无统计学意义（P〉0.05）。52例患者随访6-24个月,术后未见肿瘤复发。结论 SAE联合腹腔镜肿瘤剜除术治疗RAML能够降低手术创伤、促进术后康复并保护肾功能,可安全应用。

Objective To study the clinical effect of preoperative selective arterial embolization（SAE） and laparoscopic enucleation of tumor surgery on renal angiomyolipoma（RAML）. Methods The clinical data of 52 patients with RAML hospitalized from January 2014 to January 2016 in our hospital were respectively analyzed, of which 22 cases were treated by retroperitoneal laparoscopic enucleation 24 hours after SAE （group SAE） ,30 cases received laparoscopic enucleation of tumor treatment （non SAE group）. The clinical effect of patients be- tween two groups were compared. Results The success rate of tumor enucleating of SAE group was 100% （22/22）, which was higher than 66.67 % （20/30） of non SAE group, and the difference had statistical significance （ P 〈 0.05 ）. The amount of blood loss, operation time, time of renal artery occlusion, gastrointestinal function recovery time of SAE group were less than those of non SAE group （ P 〈 0.05 ）, the hospitali- zation time was significantly longer than that of non SAE group, the differences were statistical significance （ P 〈 0.05 ）. After 3 months of op- eration, there was no significant difference in eGFR between the two groups （P 〉 0.05 ）, the Scr of SAE group was significantly lower than that of non SAE group, the difference was significant （ P 〈 0.05 ）. The postoperative complication rate of SAE group was 4.55% （ 1/22 ）, lower than 10.00% （3/30） of the non SAE group, the difference had no statistical significance （ P 〉 0.05 ）. All of 52 patietns were followed up from 6 months to 24 months, no tumor recurrence after surgery was found. Conclusion SAE combined with laparoscopic enucleation in treatment of RAML can reduce the surgical trauma,improve postoperative rehabilitation and protect renal function,which was safe application.