肾周脂肪粘连对腹腔镜下保留肾单位手术的影响

Impact of adherent perirenal fat on laparoscopic nephron sparing surgery

目的探讨肾周脂肪粘连(APF)对腹腔镜下保留肾单位手术(NSS)的影响。方法收集本院2015年11月至2017年11月共94例腹腔镜下NSS病例,根据术中的情况分为APF组和非APF组,比较两组患者术前变量和手术时间、术中出血量、输血率、切缘阳性率、热缺血时间、中转开放率、术后引流管带管天数及术后住院天数。结果APF的发生率为36.2%(34/60),多见于男性、肥胖患者;APF的出现显著延长手术时间([148.8±22.6)min比(108.7±18.9)min,P=0.000],增加术中出血量([399.1±239.9)ml比(270.8±184.9)ml,P=0.005]、输血率(38.2%比18.3%,P=0.033)、中转开放率(26.5%比8.3%,P=0.018)、术后引流管带管天数[(4.3±0.9)d比(3.1±0.6),P=0.000]和术后住院天数[(7.9±1.4)d比(6.3±0.8)d,P=0.000];两组的切缘阳性率和热缺血时间比较差异均无统计学意义(均P>0.05)。结论APF使得腹腔镜下NSS中的肿瘤显露变得困难,增加了手术难度,但并不影响肿瘤切除后的效果。

Objective To study the effect of adherent perirenal fat (APF) on laparoscopic nephron sparing surgery (NSS). Methods A total of 94 cases of laparoscopic NSS in our hospital from November 2015 to November 2017 were collected and were divided into APF group and non-APF group according to intraoperative conditions. Preoperative variables and operation time, intraoperative blood loss, transfusion rate, positive margins, warm ischemia time, rate of conversion to open surgery, drainage time after surgery, and postoperative hospital stay were compared between the two groups. Results The incidence of APF was 36.2%(34/60), more common in males and obese patients. The appearance of APF significantly prolonged the operation time [(148.8±22.6) min vs.(108.7±18.9)min, P=0.000], increased intraoperative blood loss [(399.1±239.9)ml vs.(270.8±184.9) ml, P=0.005], transfusion rate (38.2% vs.18.3%, P=0.033), rate of conversion to open surgery (26.5% vs.8.3%, P=0.018), postoperative drainage time [(4.3±0.9)d vs.(3.1±0.6)d, P=0.000], and postoperative hospital stay [(7.9±1.4)d vs.(6.3±0.8)d, P=0.000]. There were no statistically significant differences in positive margins and warm ischemia time between the two groups (P>0.05). Conclusion APF makes it difficult to isolate the tumor in laparoscopic NSS, which increases the difficulty of operation but does not affect the effect of tumor resection.