肾肿瘤靶血管定位法在零缺血腹腔镜下肾部分切除术中的应用

Application of target vessel localization of renal tumor in zero ischemia laparoscopic partial nephrectomy

目的探讨肾肿瘤靶血管定位法在零缺血腹腔镜下肾部分切除术中的安全性和疗效。方法回顾性分析2019年1月-2020年9月上海交通大学医学院附属仁济医院泌尿外科收治的80例早期肾癌患者的资料,根据手术方式及肿瘤位置进行分组,其中30例患者为零缺血组,50例患者为传统手术组,分别比较零缺血组与传统手术组、零缺血组中肾门部与其他部位患者的手术时间、术中出血量、住院时间等资料。结果传统手术组患者手术均顺利完成,零缺血组患者中4例中途阻断肾动脉后行保留肾单位手术,其余26例患者均完成零缺血保留肾单位手术。零缺血组较传统手术组的手术时间[(92.5±9.8)min vs.(71.6±9.9)min,P<0.001]、术中出血量[(150±22)mL vs.(80±19)mL,P<0.001]有所增加,住院时间差异无统计学意义。肾门部肿瘤患者与其他部位患者相比,手术时间有所延长[(109.3±10.2)min vs.(87.3±9.5)min,P<0.001],术中出血量及住院时间差异均无统计学意义。两组患者术后随访时未发生出血、尿漏等并发症及肿瘤复发转移。术后3个月零缺血组患者的肾小球滤过率(GFR)恢复较快(P<0.05),血清肌酐水平差异无统计学意义(P>0.05)。结论对于部分早期肾癌患者,应用三维肾肿瘤血管重建技术能够更好地实现腹腔镜下零缺血保留肾单位手术,有利于患者肾功能的保护。

Objective To investigate the safety and efficacy of renal tumor target vessel localization in zero ischemia laparoscopic partial nephrectomy.Methods A total of 80 patients with early renal cancer treated in our hospital during Jan.2019 and Sep.2020 were randomly divided into two groups:30 patients in the zero ischemia group and 50 in the traditional operation group.The operation time,intraoperative bleeding and hospital stay were compared between the two groups,and between patients with tumor in the renal hilum and patients with tumors in other parts in the zero ischemia group.Results All operations were successfully completed in the traditional operation group.In the zero ischemia group,4 patients underwent nephron sparing surgery after renal arteries were blocked,and the other 26 patients completed zero ischemia nephron sparing surgery.Compared with the traditional operation group,the zero ischemia group had longer operation time[(92.5±9.8)min vs.(71.6±9.9)min,P<0.001]and increased amount of intraoperative bleeding[(150±22)mL vs.(80±19)mL,P<0.001],but there was no significant difference in hospital stay.The operation time of patients with hilar tumors was longer than that of patients with tumors in other parts[(109.3±10.2)min vs.87.3±9.5)min,P<0.001].There were no complications such as bleeding,urinary leakage and tumor recurrence and metastasis in either group.Three months after operation,glomerular filtration rate(GFR)recovered more rapidly in the zero ischemia group(P<0.05),while there was no significant difference in serum creatinine(P>0.05).Conclusion For some patients with early renal cancer,the application of three-dimensional renal tumor vascular reconstruction technology can better realize laparoscopic zero ischemia nephron sparing surgery,which is conducive to the preservation of renal function.