超选择性肾分支动脉栓塞联合零缺血后LPN对T1期肾癌患者术后肾功能影响

Effect of superselective branch renal artery embolization combined with zero-ischemic laparoscopic partial nephrectomy on postoperative renal function in patients with stage T1 renal cancer

目的探讨数字减影技术(DSA)超选择性肾分支动脉栓塞联合零缺血后腹腔镜肾部分切除术(LPN)治疗T1期肾癌的安全性及对患者肾功能的影响。方法选择2017年5月至2020年4月在本院因T1期肾癌行后LPN的39例患者,术前1~12 h先在介入手术室行DSA超选择性肾肿瘤靶动脉栓塞,然后再行后腹腔镜下零缺血肾部分切除术。对患者的手术时间、术中出血量、术后胃肠道功能恢复所需时间、术后住院时间等进行分析,比较术前24 h和术后24 h、7 d、30 d的血尿素氮(BUN)、血肌酐(Scr)水平,同时对患者术前及术后6个月的分肾小球滤过率(GFR)结果进行分析。结果所有手术均成功完成。患者手术时间为(123.2±7.6)min,术中出血量为(108.5±66.3)mL,术后胃肠道功能恢复时间为(2.5±0.6)d,术后住院时间为(7.6±1.5)d。术前及术后的Scr、BUN水平比较,差异均无统计学意义(均P>0.05);术后6个月患肾的GFR为(45.6±8.4)mL/min,较术前的(59.0±9.5)mL/min降低(P<0.001),而健侧肾的术后GFR为(68.6±11.5)mL/min,较术前的(63.3±10.5)mL/min升高,但差异无统计学意义(P=0.204)。术后随访12~36个月,无肿瘤复发及转移。结论超选择性分支肾动脉栓塞联合零缺血后LPN治疗T1期肾癌是一种安全可行的方法,对于患者术后的肾功能影响不大,值得推广。

Objective To investigate the safety of digital subtraction technique(DSA)combined with zero-ischemic laparoscopic partial nephrectomy(LPN)in the treatment of stage T1 renal tumors and its effect on renal function.Methods From May 2017 to April 2020,a total of 39 patients who underwent retroperitoneal LPN for T1 renal tumors in our hospital.DSA superselective target artery embolization was performed at the interventional operating room 1-12 hours before laparoscopic partial nephrectomy with zero ischemia.The patients′operation time,intraoperative blood loss,postoperative gastrointestinal function recovery time,postoperative hospitalization time and so on were analyzed,compared preoperative 24 h and postoperative 24 h,7 d,30 d blood urea nitrogen(BUN),blood creatinine(Scr)level,at the same time,the patient′s preoperative and postoperative 6 months of glomerular filtration rate(GFR)results were analyzed.Results All the operations were completed successfully.The intraoperative operation time was(123.2±7.6)min.The intraoperative blood loss was(108.5±66.3)mL,and the recovery time of gastrointestinal function was(2.5±0.6)d,the postoperative hospital stay was(7.6±1.5)d,There was no statistical differences in Scr and BUN before and after operation(all P>0.05).The GFR of renal patients 6 months after operation was(45.6±8.4)mL/min,which was significantly lower than that before operation(59.0±9.5)mL/min,and the difference was statistically significant(P<0.001).The postoperative GFR of healthy side kidney was(68.6±11.5)mL/min,which was higher than that of preoperative(63.3±10.5)mL/min,but the difference was not statistically significant(P=0.204).The follow-up was 12 to 36 months,and no tumor recurrence or metastasis was found.Conclusions Superselective renal artery embolization combined with zero ischemia LPN is safe and feasible in the treatment of T1 stage renal cell carcinoma patients.