腹腔镜下原位低温灌注技术在肾肿瘤部分切除术中的运用

Application of laparoscopic situ hypothermia perfusion in partial nephrectomy of renal tumors

目的探讨腹腔镜下原位低温灌注技术在肾肿瘤部分切除术中的运用,评估可行性及安全性。方法行腹腔镜肾肿瘤部分切术的患者26例,将26例患者随机分为实验组和对照组,每组各13例。实验组采用自制灌注设备,将两根管道从Trocar旁间隙导入体内,穿刺肾动脉进行灌注,将静脉回流液导出体外。对照组按照常规手术方式进行手术。比较两组患者平均手术时间、出血量、灌注时间和术前肌酐。结果 26例患者手术均获成功,实验组体重指数(BMI)为(24.5±3.1)kg/m^2,Radius Exophytic Nearness Anterior Location评分(RENAL)为(3.1±1.1)分,肿瘤直径(3.1±1.1)cm,平均手术时间(15.8±4.1)分钟,出血量(58±8)ml,灌注时间平均5.4秒,术前肌酐(58±11)mmol/L;对照组BMI为(26.0±2.4))kg/m2,RENAL评分(3.3±0.7)分,肿瘤直径(3.2±0.9)cm,平均手术时间(16.5±7.5)分钟,出血量(46±9)ml。两组病例肿瘤大小、手术时间及出血量比较,差异无统计学意义。实验组与对照组术后1周、1个月、3个月肌酐比较,差异有统计学意义(P<0.05),实验组所有病例术后早期肾功能评价优于对照组。所有肿瘤切缘均为阴性。结论采用腹腔镜下原位低温灌注技术,可以将肾脏热缺血变为肾脏冷缺血,为延长手术时间提供保障,同时能够更好的保护肾脏功能。

Objective To discuss the application of laparoscopic situ hypothermia perfusion in partial nephrectomy of renal tumors and evaluate its feasibility and safety. Methods A total of 26 cases were randomly divided into experimental group and control group（ each 13 cases）,All cases of inclusion criteria were single vessel,T1 tumor,The experimental group used a self-priming device： the specific step was to free the arterial vein first,the two pipe from Trocar import clearance by the body,exports the venous reflux fluid. The control group operated on a routine procedure. The two groups were compared with average operation time,the bleeding,the bleeding and the bleeding. Results All 26 cases were successful surgery,the experimental group body mass index（ BMI） was（ 24. 5 ± 3. 1） kg/m^2,the Radius Exophytic Nearness Anterior Location score（ RENAL） was 3. 1 ± 1. 1,tumor size was（ 3. 1 ± 1. 1） cm,the average operation time was（ 15. 8 ± 4. 1） min,the bleeding was（ 58 ± 8） ml,perfusion time average was 5. 4 s,preoperative creatinine was（ 58 ± 11） mmol/L. BMI of control group was（ 26. 0 ± 2. 4） kg/m2,RENAL score was 3. 3 ± 0. 7,tumor size was（ 3. 2 ± 0. 9） cm,the average operation time was（ 16. 5 ± 7. 5） min,the bleeding was（ 46 ± 9） ml. The two group had a weekly,one month,and three month creatinine comparision,there were statistically significant（ P〈0. 05）,and the postoperative renal function of experimental group was better than the control group in all cases. All tumor cutting edge was negative. Conclusion the laparoscopic situ perfusion technique in low temperature,can chang kidney warm into kidney cold ischemia,which can provide security to prolong operation time,at the same time can protect renal function very well.