肾动脉不同阻断方式对后腹腔镜下保留肾单位手术的临床疗效分析

Analysis of clinical curative effect of using different blocking methods to renal artery in laparoscopic nephron sparing surgery

目的探讨肾动脉不同的阻断方式对后腹腔镜下保留肾单位手术的临床疗效。方法选择行后腹腔镜下保留肾单位手术的肾肿瘤手术患者118例为研究对象,根据肾动脉阻断方式的不同分为全阻断组61例和选择性阻断组57例,比较两组患者的临床疗效。结果两组年龄、性别、患肾部位和切除部位差异均无统计学意义(均P>0.05)。全阻断组阻断时间、手术时间、术中出血量、术后第1天引流量分别为(22.58±4.62)min、(138.75±21.76)min、(108.47±75.39)mL、(137.36±18.34)mL,选择性阻断组分别为(28.61±4.59)min、(103.26±18.64)min、(132.58±68.43)mL、(163.15±15.87)mL,两组差异均有统计学意义(t=5.356、-8.247、7.463、10.358,均P<0.01);两组术后住院时间[(8.36±2.19)d比(7.78±2.35)d]差异无统计学意义(P>0.05)。两组术前肌酐水平和肾小球滤过率差异无统计学意义(P>0.05);术后,全阻断组肌酐、肾小球滤过率分别为(106.38±32.76)μmol/L、(33.53±6.14)%,选择性阻断组分别为(95.26±25.49)μmol/L、(38.27±5.29)%,两组差异均有统计学意义(t=-2.154、4.572,均P<0.05)。结论肾动脉全阻断术的手术时间较短,出血量较大,术后肌酐上升较多,肾小球滤过率降低明显,对于较小的单肾手术尽量采用选择性肾动脉阻断术,术中出血少,术后效果更好。

Objective To explore the clinical curative effect of using different blocking methods to renal artery in laparoscopic nephron sparing surgery.MethodsA total of 118 cases admitted in the Affiliated Heji Hospital of Changzhi Medical College who reserved the nephron routine after laparoscopic surgery of renal tumor surgery were selected.According to different methods of renal artery block,the patients were divided into the whole block group(61 cases)and selective blocking group(57 cases).The clinical curative effects of the two groups were compared.ResultsThe differences of age,sex,suffering from kidney area and excising were not statistically significant between the two groups(all P>0.05).The blocking time,operation time and intraoperative blood loss,drainage at postoperative 1 day in the whole block group were(22.58±4.62)min,(138.75±21.76)min,(108.47±75.39)mL and(137.36±18.34)mL,respectively,which in the selective block group were(28.61±4.59)min,(103.26±18.64)min,(132.58±68.43)mL and(163.15±15.87)mL,respectively,the differences were significant between the two groups(t=5.356,-8.247,7.463,10.358,all P<0.01).The postoperative hospital stay[(8.36±2.19)d vs.(7.78±2.35)d]had no statistically significant difference between the two groups(P>0.05).There were no statistically significant differences in preoperative creatinine level and glomerular filtration rate between the two groups(all P>0.05).After operation,the creatinine and glomerular filtration rate in the whole block group were(106.38±32.76)μmol/L,(33.53±6.14)%statistically,which in the selective block group were(95.26±25.49)μmol/L,(38.27±5.29)%statistically,the differences were statistically significant between the two groups(t=-2.154,4.572,all P<0.05).ConclusionRenal artery block has shorter operation time,larger haemorrhage amount,increased postoperative creatinine,reduced glomerular filtration rate,for a small single kidney surgery,using selective renal artery block as far as possible,it has less intraoperative bleeding,and postoperative effect is better.