T1期肾肿瘤个性化“缩短热缺血时间”技术辅助腹腔镜肾部分切除术的方案选择及临床应用研究

Selection of personalized shortened warm ischemia time in laparoscopic partial nephrectomy based on the T1 renal tumors characteristics

目的:目的:探讨个性化"缩短热缺血时间"技术辅助腹腔镜肾部分切除术治疗T1期肾肿瘤的安全性及有效性。方法:回顾分析2014年1月至2018年1月接受腹腔镜下肾部分切除术的189例T1期肾肿瘤患者的临床资料。其中男112例,女77例,平均(56.51±14.31)岁,肿瘤直径平均(3.80±1.68)cm,内生型78例,外生型111例,平均R.E.N.A.L评分(7.45±1.78)分。个性化"缩短热缺血时间"技术组分为:标准无阻断技术、预留缝线无阻断技术、术前DSA超选栓塞无阻断技术、早期序贯开放血流法、肾动脉全阻断(2+1缝合法)。结果:189例患者均顺利完成腹腔镜下肾部分切除术。97例个性化选择的患者中83例(85.6%)完成个性化手术方式,入选个性化组;92例肾癌患者入选传统组(全阻断)。两组患者术前临床资料差异无统计学意义。个性化组手术时间、术中出血量多于传统组(P<0.001),两组术后血红蛋白改变、术后住院时间等差异无统计学意义。术后第6个月、第12个月,个性化组肾功能恢复情况占优势,差异有统计学意义。结论:个性化"缩短热缺血时间"技术利用肿瘤的特性选择合理的术式,尽可能保护患者术后肾功能,安全可行。

Objective:To explore the safety and effectiveness of a personalized shortened warm ischemia time in laparoscopic partial nephrectomy for the T1 renal tumors.Methods:Clinical data of 189 patients with T1 renal tumor who underwent laparoscopic partial nephrectomy from Jan.2014 to Jan.2018 were retrospectively analyzed.There were 112 males and 77 females with an average age of(56.51±14.31) years old and a mean tumor diameter of(3.80±1.68)cm.The endogenous and exogenous tumor was 78 cases and 111 cases,respectively.The average R.E.N.A.L score was(7.45±1.78) points.The personalized "shortened warm ischemia time" included standard non-clamp,preplaced suture technique,superselective embolization,early sequential unclamping,total renal artery block( "2+1" technology).Results:All patients with T1 renal tumor underwent laparoscopic partial nephrectomy successfully.In personalized shortened warm ischemic time group,83 patients(85.6%) underwent surgery and were enrolled in the personalized group;92 patients were enrolled in the traditional group(full block).Baseline of two groups had no statistical difference,including gender,age,ASA score,mean tumor diameter,tumor stage,tumor location,and R.E.N.A.L score.The operation time and estimated blood loss in the personalized group was more(P<0.001),there was no significant difference in postoperative hemoglobin change or postoperative hospital stay.The renal function of the individualized group clearly had an advantage in 6 months and 12 months after surgery.Conclusions:Personalized "shortened warm ischemia time" selects reasonable surgical approach based on the characteristics of the tumor,in order to protect the patient’s postoperative renal function,clinical safety and feasibility.