腹腔镜辅助下行完全不阻断肾脏部分切除术的临床可行性研究

Clinical feasibility of assisted laparoscopic partial nephrectomy without renal hilar artery clamping

目的探讨腹腔镜辅助下行完全不阻断肾脏部分切除术(LPN)的临床可行性。方法选择2013年1月至2015年1月期间河北医科大学附属沧州中心医院收治的30例T1a期肾脏肿瘤患者为研究对象,将其中12例行完全阻断LPN者设为对照组,18例行完全不阻断LPN者设为观察组。比较两组患者的手术时间、术中出血量、术中输血率、术后出血情况、手术前后血清肌酐水平、住院时间及并发症等情况。结果两组患者手术均获得成功,且未见术后出血;观察组患者手术时间为(96.3±16.8)min,明显低于对照组的(112.1±15.6)min,差异有统计学意义(P<0.05);观察组患者术中出血量、术中输血率和住院时间分别为(108.1±19.3)m L、5.6%和(9.3±1.5)d,对照组依次为(97.3±18.9)min、8.3%,和(9.1±1.7)d,两组间比较差异均无统计学意义(P>0.05);两组患者术后1 d血清肌酐浓度明显升高,随后缓慢降低;观察组术前及术后1 d、3 d、7 d肌酐水平分别为(76.3±13.8)μmol/L、(109.3±14.2)μmol/L、(99.7±11.3)μmol/L、(90.4±11.9)μmol/L,对照组依次为(82.2±12.6)μmol/L、(112.7±17.3)μmol/L、(100.8±10.9)μmol/L、(93.1±12.2)μmol/L,两组术后1 d、3 d、7 d肌酐水平均明显高于本组术前(P<0.05),但两组同期肌酐水平间比较差异均无统计学意义(P>0.05);观察组并发症发生率为0,与对照组的8.3%比较差异无统计学意义(P>0.05);随访11个月,两组均无局部复发或转移。结论腹腔镜下行完全不阻断肾脏部分切除术具有与腹腔镜下行完全阻断肾脏部分切除术同等的疗效,并可有效避免因肾脏缺血而造成的患侧肾功能损伤,降低肾衰竭风险,临床可行性较高。

Objective To investigate the clinical feasibility of assisted laparoscopic partial nephrectomy(LPN)without renal hilar artery clamping. Methods Thirty patients with stage T1 a renal cancer treated in the Cangzhou Central Hospital Affiliated to Hebei Medical University from January 2013 to January 2015 were selected as research objects. Twelve of the patients who underwent LPN with complete renal hilar artery clamping were set as the control group, and another 18 patients who underwent LPN without renal hilar artery clamping were regarded as the observation group. The operation time, intraoperative blood loss, intraoperative blood transfusion rate, postoperative bleeding, serum creatinine level before and after the operation, length of hospital stay and complications were compared between the two groups. Results The operation of the two groups were successful, and there was no postoperative bleeding. The operation time in the observation group was(96.3±16.8) min, which was significantly lower than that in the control group of(112.1±15.6) min, and the difference was statistically significant(P<0.05). The intraoperative blood loss, intraoperative blood transfusion rate and length of hospital stay in the observation group were respectively(108.1±19.3) m L, 5.6% and(9.3±1.5) d, and those in the control group were respectively(97.3±18.9) min, 8.3% and(9.1±1.7) d. There were no significant differences between the two groups(P>0.05). The serum creatinine concentration of patients significantly increased after one day of the operation between the two groups, and then slowly decreased. The creatinine levels at the preoperative and postoperative 1 d, 3 d and 7 d of the observation group were respectively(76.3 ± 13.8) μ mol/L,(109.3 ± 14.2) μ mol/L,(99.7 ± 11.3) μ mol/L,(90.4 ± 11.9) μ mol/L, and those of the control group were respectively(82.2±12.6) μmol/L,(112.7±17.3) μmol/L,(100.8±10.9) μmol/L,(93.1±12.2) μmol/L. The creatinine levels at postoperative 1 d, 3 d and 7 d in the two groups after the operation were significantly higher than those before the operation(P<0.05), but there was no significant difference in the serum creatinine level between the two groups(P>0.05). The complication rate of observation group was 0, which showed no significant difference with that of the control group of 8.3%(P>0.05). The patients were followed up for 11 months, and there was no local recurrence or metastasis in the two groups.Conclusion Assisted laparoscopic partial nephrectomy without renal hilar artery clamping has the same clinical effect with LPN with complete renal hilar artery clamping, which can effectively avoid the ipsilateral renal function damage caused by renal ischemia, and reduce the risk of renal failure, with higher clinical feasibility.