高选择性肾动脉分支阻断术在腹腔镜肾部分切除术中的应用

Application of highly selective damping of renal arterial branches in laparoscopic partial nephrectomy

目的探讨高选择性肾动脉分支阻断技术在腹腔镜肾部分切除术中的临床应用及价值。方法 2012年6月至2016年6月期间,江门市中心医院对18例肾肿瘤患者行腹腔镜肾部分切除术,术中采用高选择性肾动脉分支阻断术。其中男10例,女8例,平均年龄(49±14)岁,平均肿瘤直径约(3.2±0.7)cm。观察手术时间、肾动脉分支阻断时间、术中出血量、留置引流管时间、术后住院时间、肾功能改变情况、并发症及手术效果。结果手术均顺利完成,手术时间(102±12)min,术中出血量(89±13)ml,术中肾动脉分支阻断时间(28±5)min,无输血、中转开放手术病例。术中、术后无重大并发症,肾周引流管留置时间(4.3±1.0)d,术后住院时间(6.0±1.5)d,手术前后患肾肾小球滤过率(GFR)无明显变化,术前为(44±4)ml/min,术后1个月为(42±4)ml/min,差异无统计学意义(P>0.05)。术后随访4~51个月。结论高选择性肾动脉分支阻断技术是一种新的肾动脉阻断技术,在腹腔镜肾部分切除术中安全有效,但需要长期随访及大宗病例研究。

Objective To explore the feasibility and efficiency of highly selective damping technique of renal arterial branches during laparoscopic partial nephrectomy. Method Between June 2012 and June 2016, 18 patients（10 males, 8 females） with renal tumor underwent laparoscopic partial nephrectomy with highly selective clamping of renal arterial branches. The meal age was（49±14） years and the mean tumor size was（3.2±0.7） cm. Operative time, time for highly selective clamping of renal arterial branches, estimated blood loss, indwelling duration of drainage tube, postoperative hospital stay, renal funtiong change and complications were recorded. Results The operations were successfully performed in all patients. The mean operative duration time was（102±12） min, the mean estimated blood loss was（89±13） ml and the mean time for the clamping of renal arterial branches was（28±5） min. There were neither blood transfusion nor conversion to open surgery. The mean indwelling duration of drainage tube was（4.3±1.0） days and the mean postoperative hospital stay was（6.0±1.5） days. There was no significant difference in the glomerular filtration rate（GFR） between the preoperative and one month postoperative. The follow-up was 4-51 months and the recovery of all patients was uneventful. Conclusion Highly selective clamping of renal arterial branches is a new method of protecting renal function during laparoscopic partial nephrectomy. Further studies and a longer follow-up are warranted.