经腹腔镜肾动脉分支阻断肾部分切除术治疗早期肾肿瘤的临床应用
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摘要
目的探讨经腹腔镜肾动脉分支阻断肾部分切除术在治疗早期肾肿瘤中的临床应用及效果。方法回顾性分析2016年12月-2018年1月新疆医科大学第一附属医院泌尿外科收治的15例肾肿瘤患者的临床资料,男性12例,女性3例,肿瘤直径(3.5±0.8)cm。11例患者术中均采用肾动脉分支阻断肾部分切除术。术前及术后1个月分别行核素扫描(ECT)检测肾小球滤过率(GFR),评价患者的分肾功能变化情况。10例采取经腹腹腔镜入路,5例采用后腹腔入路。观察手术时间、肾动脉分支阻断时间、术中出血量、术后住院时间、肾功能改变及并发症情况。结果手术均顺利完成,手术时间为(125.8±13.2)min,术中肾动脉分支阻断时间为(22.4±5.6)min,术中出血量为(233.3±30.5)mL,术后住院时间为(6.8±1.7)d,手术前后患肾GFR无明显变化,术前为(45.2±3.1)mL/min,术后1个月为(43.5±2.7)mL/min,差异无统计学意义(P>0.05)。无输血及术中中转开放病例。术后随访3～15个月,无出血、漏尿等相关并发症发生。结论经腹腔镜肾动脉分支阻断肾部分切除术是一种新的手术方式,治疗早期肾癌安全可靠,可以更好地保护肾功能。
Objective To explore the feasibility and efficiency of laparoscopic partial nephrectomy with segmental renal artery clamping technique in the treatment of early renal tumor.Methods The clinical data of15 patients with renal tumors admitted to Urology Department of the First Affiliated Hospital of Xinjiang Medical University from December 2016 to January 2018 were retrospectively analyzed.There were 12 males and 3females,and the diameter of the tumors was(3.5±0.8)cm.All 11 patients underwent partial nephrectomy with branch of renal artery occlusion.The glomerular filtration rate(GFR)was measured by radionuclide scanning(ECT)before and 1month after operation,and the changes of renal function were evaluated.Transabdominal laparoscopic approach was used in 10 cases and retroperitoneal approach was used in 5cases.The operation time,renal artery branch occlusion time,intraoperative blood loss,hospital stay length,renal function changes and complications were observed.Results The operations were successfully performed in all patients.The mean operative time was(125.8±13.2)min,the mean occlusion time of renal arterial branches was(22.4±5.6)min and the mean intraoperative blood loss was(233.3±30.5)mL.The mean hospital stay length was(6.8±1.7)days.There was no significant difference in GFR between the preoperative and one month postoperative.Follow-up for 3to 15 months showed no complications such as bleeding or leakage of urine.Conclusion The segmental renal artery clamping technique is a new branch of renal artery blocking technique that is safe and effective for the treatment of early renal tumors.
Objective To explore the feasibility and efficiency of laparoscopic partial nephrectomy with segmental renal artery clamping technique in the treatment of early renal tumor.Methods The clinical data of15 patients with renal tumors admitted to Urology Department of the First Affiliated Hospital of Xinjiang Medical University from December 2016 to January 2018 were retrospectively analyzed.There were 12 males and 3females,and the diameter of the tumors was(3.5±0.8)cm.All 11 patients underwent partial nephrectomy with branch of renal artery occlusion.The glomerular filtration rate(GFR)was measured by radionuclide scanning(ECT)before and 1month after operation,and the changes of renal function were evaluated.Transabdominal laparoscopic approach was used in 10 cases and retroperitoneal approach was used in 5cases.The operation time,renal artery branch occlusion time,intraoperative blood loss,hospital stay length,renal function changes and complications were observed.Results The operations were successfully performed in all patients.The mean operative time was(125.8±13.2)min,the mean occlusion time of renal arterial branches was(22.4±5.6)min and the mean intraoperative blood loss was(233.3±30.5)mL.The mean hospital stay length was(6.8±1.7)days.There was no significant difference in GFR between the preoperative and one month postoperative.Follow-up for 3to 15 months showed no complications such as bleeding or leakage of urine.Conclusion The segmental renal artery clamping technique is a new branch of renal artery blocking technique that is safe and effective for the treatment of early renal tumors.
引文
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[18]吴震杰,刘冰,王坚超,等.机器人单孔腹腔镜下零缺血肾部分切除术的初步应用经验[J].中华泌尿外科杂志,2017,38(7):498-501.
[19]马鑫,黄庆波,刘启明.肾动脉低温灌注机器人辅助腹腔镜下肾部分切除术治疗完全内生性肿瘤的疗效分析[J].中华泌尿外科杂志,2016,37(10):721-725.
[20] LI C C,YEH H C,LEE H Y,et al.Laparoscopic partial nephrectomy without intracorporeal suturing[J].Surg Endosc,2016,30(4):1585-1591.
[2] LJUNGBERG B,BENSALAH K,CANFIELD S,et al.EAU guidelines on renal cell carcinoma:2014update[J].Eur Urol,2015,67(5):913-924.
[3] GILL I S,EISENBERG M S,ARON M,et al.“Zero ischemia”partial nephrectomy:novel laparoscopic and robotic technique[J].Eur Urol,2011,59(1):128-134.
[4] SHAO P,QIN C,YIN C,et al.Laparoscopic partial nephrectomy with segmental renal artery clamping:technique and clinical outcomes[J].Eur Urol,2011,59(5):849-855.
[5]MIR M C,DERWEESH I,PORPIGLIA F,et al.Partial nephrectomy versus radical nephrectomy for clinical and Renal tumors:a systcmatic review T1band T2meta-analysis of comparative studies[J].Eur Urol,2017,71(4):606-617.
[6] KLATTE T,FICARRA V,GRATZKE C,et al.A literature review of renal surgical anatomy and surgical strategies for partial nephrectomy[J].Eur Urol,2015,68(6):980-992.
[7] DESAI M M,DE-CASTRO ABREU A L,LESLIE S,et al.Robotic partial nephrectomy with superselective versus main artery clamping:a retrospective comparison[J].Eur Urol,2014,66(4):713-719.
[8] Lanchon C,Arnoux V,Fiard G,et al.Super-selective robotassisted partial nephrectomy using near-infrared urorescence versus early-unclamping of the renal artery:results of a prospective matched-pair analysis[J].Int Braz J Urol,2018,44(1):53-62.
[9] WSZOLEK M F,KENNEY P A,LEE Y,et al.Comparison of hilar clamping and nonhliar clamping partial nephrectomy for tumours involving a solitary kidney[J].BJU Int,2011,107(12):1886-1892.
[10] THOMPSON R H,LANE R B,LOHSE C M,et al.Every minute counts when the renal hilum is clamped during partial nephrectomy[J].Eur Urol,2010,58(3):340-345.
[11] SMITH G L,KENNEY P A,LEE Y,et al.Non-clamped partial nephrectomy:techniques and surgical outcomes[J].BJU Int,2011,107(7):1054-1058.
[12] LI P U,QIN C,CAO A Q,et al.A retrospective analysis of laparoscopic partial nephrectomy with segmental renal artery clamping and factors that predict postoperative renal function[J].BJU Int,2016,118(5):610-617.
[13] NG C K,GILL I S,PATIL M B,et al.Anatomic renal artery branch microdissection to facilitate zero-ischemia partial nephrectomy[J].Eur Urol,2012,61(1):67-74.
[14] ABREU A L,GILL I S,DESAI M M.Zero-ischaemia robotic partial nephrectomy(RPN)for hilar tumours[J].BJU Int,2011,108(6Pt 2):948-954.
[15] YU Y J,LIANG C,BAO M L,et al.Retroperitoneal laparoscopic partial nephrectomy with segmental renal artery clamping for cancer of the left upper calyx:a case report[J].BMC Urol,2017,17(1):73.
[16]杨波,张超,过菲,等.“蛙跳式”腹腔镜分支动脉选择性阻断的肾肿瘤部分切除术[J].现代泌尿外科杂志,2017,22(9):653-656.
[17] ZHU J D,JIANG F,LI P,et al.Application and analysis of retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping for patients with multiple renal tumor:initial experience[J].BMC Urol,2017,17(1):82.
[18]吴震杰,刘冰,王坚超,等.机器人单孔腹腔镜下零缺血肾部分切除术的初步应用经验[J].中华泌尿外科杂志,2017,38(7):498-501.
[19]马鑫,黄庆波,刘启明.肾动脉低温灌注机器人辅助腹腔镜下肾部分切除术治疗完全内生性肿瘤的疗效分析[J].中华泌尿外科杂志,2016,37(10):721-725.
[20] LI C C,YEH H C,LEE H Y,et al.Laparoscopic partial nephrectomy without intracorporeal suturing[J].Surg Endosc,2016,30(4):1585-1591.