后腹腔镜下选择性肾动脉栓塞与肾动脉阻断行肾错构瘤剜切除术的比较

Comparison of retroperitoneal laparoscopic enucleation with selective renal arterial embolization (SAE) and NonSAE for renal angiomyolipoma

目的比较后腹腔镜下选择性肾动脉栓塞与肾动脉阻断行肾错构瘤剜切除术的安全性及有效性。方法分析我院2010年1月至2015年12月行腹腔镜下肾错构瘤切除患者的临床资料,共163例,其中选择性肾动脉栓塞后肿瘤吸引及剜除33例,肾动脉阻断肿瘤切除130例,术中行冰冻检查27例,比较两种术式在手术时间、术中出血、术后出血、住院时间等方面的差异。结果所有病例一期在腹腔镜下完成肿瘤切除,介入后肿瘤剜除或吸出33例,术中出血(ml)、手术时间(min)、术后住院时间(d)和费用(万元)分别为:(41±13)、(47±15)、(3.50±0.24)、(1.63±0.29);动脉阻断组130例,相应指标分别为:(83±23)、(103±22)、(4.50±0.31)、(1.23±0.35),术后出血7例,栓塞止血3例,两组比较,介入组优势明显,差异显著(P<0.05)。术后病理诊断透明细胞癌5例(3.1%),术前、术后总肾功能差异无统计学意义(P>0.05),随访期间均无肿瘤复发。结论肾错构瘤选择性肾动脉栓塞后腹腔镜下切除,可以有效降低手术难度、缩短手术时间、减少术中及术后出血风险,有条件的医疗机构值得借鉴。

Objective To compare the safty and clinical efficacy of retroperitoneal laparoscopic excision after selective arterial embolization(SAE)and nonSAE in renal angiomyolipoma.Methods The clinical data of 163 patients with renal angiomyolipoma received retroperitoneal laparoscopy were enrolled from January 2010 to December 2015 in our hospital.The patients were divided into retroperitoneal laparoscopic enucleation with selective arterial embolization group(SAE group,n=33)or tumor resection with renal arterial embolization group(non SAE group,n=130).Twenty seven cases were carried out frozensection examination during operation.The differences of operative time,intra-and post-operation blood loss,length of hospitalization between the two groups were compared.Results All the patients underwent the operation successfully.Intraoperative bleeding(ml),operation time(min),postoperative length of stay(d)and cost(ten thousand yuan)of SAE group were:(41±13),(47±15),(3.50±0.24),(1.63±0.29);non SAE group were:(83±23),(103±22),(4.50±0.31),(1.23±0.35).Seven patients suffered postoperative hemorrhage and 3 were hemostasia with embolization.To compare the clinical efficacy,SAE group was slightly superior to non SAE with significant difference(P<0.05).Five cases(3.1%)were diagnosed with clear cell carcinoma by postoperative pathology.There was no significant difference in total renal function before and after operation.No tumor recurrence was observed during follow-up in two groups.Conclusions Retroperitoneal laparoscopic enucleation with selective arterial embolization in renal angiomyolipoma patients can reduce operation difficulty,shorten operation time,decrease the risk of intra-and post-operation bleeding,which can be apply in wconditional medical institutions.