零阻断免缝合技术在腹腔镜下肾部分切除术中的临床应用研究

Application of zero-ischemia and sutureless technique in laparoscopic partial nephrectomy

目的通过后腹腔镜零阻断免缝合肾部分切除术(ZS-RLPN)用于局限性肾肿瘤的临床治疗,分析该项技术对肾功能保护方面的治疗效果及安全性。方法通过对武汉科技大学附属孝感医院泌尿外科从2020年7月到2022年1月收治的25例局限性肾肿瘤患者病例资料进行回顾性分析,其中A组12例患者行阻断肾动脉的后腹腔镜肾部分切除术(RAO-RLPN),B组13例患者行ZS-RLPN,通过对比两组在术中手术时长、热缺血时间、术中出血量、术前、术后24 h内血肌酐值及血尿素氮值,术后24 h引流量、术后住院时长、术后并发症发生率(出血、感染、漏尿等)、病理切缘阳性率、输血率、术后3个月肾动态显像测定术肾肾小球滤过率(GFR),短期随访复发率、转移率等方面的整理数据,进行比较分析。结果两组术后24 h血肌酐[(84.66±4.64)μmol/L vs.(78.00±8.76)μmol/L)]、术后24 h血尿素氮[(8.06±1.18)mmol/L vs.(6.33±2.14)mmol/L)]、术中出血量[(93.25±23.65)mL vs.(138.21±13.77)mL],差异有统计学意义(P<0.05),其中术后术肾GFR[(40.06±4.67)mL/min vs.(43.22±6.15)mL/min)]差异无统计学意义(P>0.05)。结论后腹腔镜下零阻断免缝合肾部分切除术效果确切,可以最大限度保护肾功能,具有较好的临床可行性。

【Objective】To analyze the clinical application of retroperitoneal laparoscopic partial nephrectomy with zero-ischemia and sutureless(ZS-RLPN)in the treatment of limited renal tumors,and analyze the therapeutic effect and safety of this technique on renal function protection.【Methods】A retrospective analysis was performed on 25 patients with limited renal tumors admitted to the Department of Urology of Xiaogan Central Hospital from July 2020 to January 2022.In group A,12 patients underwent laparoscopic partial nephrectomy with renal artery occlusion(RAO-RLPN),and in group B,13 patients underwent ZS-RLPN.The results were compared in terms of intraoperative operative time,thermal ischemia time,intraoperative bleeding,postoperative 24-h drainage,postoperative length of stay,preoperative and postoperative 24-hour blood creatinine and urea nitrogen values,postoperative complication rate(bleeding,infection,urinary leakage,etc.),the rate of positive pathological margins,the rate of blood transfusion,the glomerular filtration rate(GFR)of the operated kidney measured by renal dynamic imaging at 3 months after surgery,and the rate of recurrence and metastasis during the short-term follow-up.【Results】24-h postoperative blood creatinine(84.66±4.64μmol/L vs.78.00±8.76μmol/L),24-h postoperative blood urea nitrogen(8.06±1.18 mmol/L vs.6.33±2.14 mmol/L),and intraoperative bleeding(93.25±23.65 mL vs.138.21±13.77 mL)in group A and group B had statistically significant difference(P<0.05),while postoperative renal GFR(40.06±4.67 mL/min vs.43.22±6.15 mL/min)showed no statistically significant difference(P>0.05).【Conclusion】The effect of posterior laparoscopic zero-block no-suture partial nephrectomy is exact,which can maximize the protection of renal function,and has better clinical feasibility.