选择性肾动脉分支阻断与肾动脉全阻断下腹腔镜肾部分切除术治疗肾肿瘤的疗效比较

Comparison of selective and complete renal artery clamping in laparoscopic retroperitoneal partial nephrectomy for renal tumors

目的比较选择性肾动脉分支阻断与肾动脉全阻断下腹腔镜肾部分切除术治疗肾肿瘤的疗效。方法回顾性分析行肾部分切除术的56例肾肿瘤患者的临床资料,根据检查结果选择是否完全阻断肾动脉,其中选择性肾动脉分支阻断25例(A组),肾动脉全阻断31例(B组)。比较两组患者手术时间、肾动脉阻断时间、术中出血量、肾小球滤过率(eGFR)变化率、手术切缘阳性情况、Clavien分级等,术后3个月复查CT观察肿瘤有无复发及肾积水情况。结果所有患者顺利完成手术,由同一组医师操作,均无手术切缘阳性;A组术中无一例中转为全阻断下手术。A、B组ClavienⅡ级各有1例。两组患者手术时间、肾动脉阻断时间、术中出血量等方面比较,差异均无统计学意义(均P>0.05);术后1d、1周和1个月时eGFR变化率比较差异有统计学意义,B组均高于A组(均P<0.01)。B组患者术后1d肾动脉阻断时间与e GFR呈负相关(r=-0.65,P<0.01),A组患者术后1d肾动脉阻断时间与eGFR未见相关(P>0.05)。术后3个月复查CT,两组患者均无肿瘤复发及远处转移,无肾积水及肾萎缩等。结论与肾动脉全阻断比较,选择性肾动脉分支阻断下腹腔镜肾部分切除术相对安全,保护正常肾单位功能的效果更优。

Objective To compare the therapeutic effect of selective renal artery clamping and total renal artery clamping in laparoscopic retroperitoneal partial nephrectomy for renal tumors. Methods The clinical data of 56 patients with renal tumors who underwent partial nephrectomy were retrospectively analyzed. Among 56 patients, there were 25 cases（group A） receiving selective renal artery clamping and 31 cases（group B） receiving total renal artery clamping. The operative time, the time of renal artery clamping, intraoperative blood loss, glomerular filtration rate（eGFR）, the positive operation margin and Clavien grading were compared between the two groups. CT scan was performed to examine for recurrence and hydronephrosis 3 months after operation. Results The operations were completed successfully in all patients. There were no positive surgical margin, no cases in group A transferred to total renal artery clamping; and 1 cases of Clavien Ⅱin group A and B, respectively. There were no significant differences in operative time, renal artery clamping time and intraoperative blood loss between the two groups（P〈0.05）. The decreased eGFR was observed at 1 d, 1 weeks and 1 months after operation, and the decrease in group B was more marked than that in group A（P〈0.01）. The renal artery clamping time was negatively correlated with eGFR at d1 after operation in group B（r=-0.65, P〈0.01）, but not in group A（P〈0.05）. CT scan showed that there were no tumor recurrence and distant metastasis 3 months after operation in the two groups; and also no hydronephrosis and renal atrophy were found. Conclusion Compared with total renal artery clamping, selective renal artery clamping is relatively safe and has better effect on protecting renal function in laparoscopic retroperitoneal partial nephrectomy for renal tumors.