肾周冰水低温技术在后腹腔镜肾部分切除术中的价值

Clinical value of perirenal ice water technique in retroperitoneal laparoscopic partial nephrectomy

目的探讨肾周冰水低温技术在后腹腔镜肾部分切除术(retroperitoneal laparoscopic partial nephrectomy,RLPN)中对患侧肾功能保护的临床价值。方法研究对象选取2014-03~2017-01于我院拟行RLPN的肾脏肿瘤患者共41例,根据术中是否采用肾脏低温技术分为研究组(n=20)和对照组(n=21)。研究组应用肾周冰水低温技术行RLPN,对照组不采用低温技术行RLPN。记录并比较两组患者手术时间、肾动脉缺血时间、术中失血量、术前及术后3月血肌酐及尿素氮值、术前和术后3月99mTc-DTPA肾动态显像法测定总肾及分肾肾小球滤过率(glomerular filtration rate,GFR)。结果 41例手术均顺利完成,术后无急性肾功能衰竭、大出血、尿漏等严重并发症,均未输血。两组患者手术时间、肾动脉阻断时间、术中失血量比较差异无统计学意义(P>0.05)。研究组和对照组术前、术后3月血肌酐和尿素氮值组间比较差异均无统计学意义(P>0.05)。组间比较两组患者术前总肾GFR及患肾GFR,差异均无统计学意义(P>0.05)。术后3月,两组患者总肾GFR比较差异无统计学意义(P>0.05),但术后3月研究组患肾GFR显著高于对照组(P<0.05)。术后随访3-24月,两组患者均无肿瘤复发及远处转移,研究组无低温技术所致相关并发症。结论应用肾周冰水低温技术行后腹腔镜下肾部分切除术治疗肾脏肿瘤安全、有效,可减轻患肾缺血热损伤,保护患肾功能,具有临床推广价值。

Objective To explore the clinical value of perirenal ice water technique in the protection of ipsilateral renal function during the retroperitoneal laparoscopic partial nephrectomy（ RLPN）. Methods From March 2014 to January 2017,41 patients with renal tumor undergoing retroperitoneal laparoscopic partial nephrectomy were chosen in our hospital and divided into study group（ n = 20） and control group（ n = 21）. The patients in study group were treated with RLPN under the protection of perirenal ice water,while the patients were performed RLPN without cryogenic technique in control group. The operation time,renal ischemia time,blood loss,preoperative and postoperative serum creatinine,and blood urea nitrogen were compared. The glomerular filtration rate（ GFR） of bilateral kidneys and affected kidneys were measured with 99 mTc-DTPA. Results All the operations were successfully performed. There were no blood transfusions and no serious complications,such as postoperative bleeding,acute renal failure,urine leakage. There was no significant difference in the operation time,renal ischemia time,blood loss between the two groups（ P〉0. 05）. There was no statistical difference in blood urea nitrogen and serum creatinine between the two groups before and after operation（ P〉0. 05）. There was no statistical difference in the total renal GFR between the two groups before and after operation（ P〉0. 05）. There was no significant difference in the affected kidney GFR between the two groups before operation. At 3 month after the surgery,the affected kidney GFR in study group was significantly higher than that in control group. All the patients were followed-up for 3-24 months,and no recurrence,distant metastasis,and complications caused by cryogenic technique were observed. Conclusion Renal hypothermia technique via perirenal ice water in retroperitoneal laparoscopic partial nephrectomy can reduce the renal ischemia reperfusion injury and effectively protect the ipsilateral renal function.