比较后腹腔镜下节段性与全肾动脉阻断肾部分切除术对术后患侧肾功能的影响

杨昊; 陈方敏; 石家齐; 李登宝; 陈程

doi:10.13201/j.issn.1001-1420.2015.05.004

比较后腹腔镜下节段性与全肾动脉阻断肾部分切除术对术后患侧肾功能的影响

- 1. 贵阳医学院(贵阳, 550004);
- 2. 贵阳医学院附属医院泌尿外科
基金项目:
贵州省科技厅国际合作项目〔编号黔科合外G字（2011）7015，黔科合J字（2013）GZ62172〕

详细信息

通讯作者: 陈方敏,E-mail:cfm_cn@aliyun.com

中图分类号: R737.11

收稿日期: 2014-12-31

The study comparing of laparoscopic segmental and non segmental renal artery block partial nephrectomy may affect postoperative side kidney function

- 1. Guiyang Medcial College, Guiyang, 550004, China;
- 2. Department of Urology, Afiliated of Guiyang Medcial College

More Information

Corresponding author: CHEN Fangmin, E-mail: cfm_cn@aliyun.com

Received Date: 31 December 2014

摘要

摘要: 目的：对比后腹腔镜节段性肾动脉阻断（SRPN）与普通全肾动脉阻断保留肾单位肾部分切除术（LPN）对术后患侧肾功能的影响。方法：回顾性分析我院2010年6月~2012年6月治疗的80例局限性肾肿瘤（SRM）患者的临床资料，其中35例患者行SRPN，另45例患者行LPN。术前行肾动态显像及GFR检查，测得患侧GFR值；术后通过电话随访，每3~6个月复查肾动态显像及GFR，监测术后患侧GFR的变化，并进行统计学分析。结果：术后3、6个月，35例行SRPN患者术后患侧GFR和术前患侧GFR分别发现2例（2/35，5.71%）、3例（3/35，8.57%）下降，下降均值分别为（0.36±0.22）、（3.96±1.45） ml/min；而45例LPN患者术后患侧GFR和术前患侧GFR分别发现25例（25/45，55.56%）、30例（30/45，66.67%）下降；下降均值分别为（6.28±0.82）、（11.47±3.22） ml/min （P<0.05）。术后随访12、18、24个月，SRPN患侧GFR与术前比较，下降分别为31.4%（11/35）、42.8%（15/35）、45.7%（16/35），下降均值分别为（8.52±2.16）、（11.02±2.23）、（13.55±2.68） ml/min；LPN分别为86.67%（39/45）、88.89%（40/45）、93.33%（42/45），下降均值分别为（12.68±3.84）、（17.73±4.82）、（20.24±4.96） ml/min （P<0.05）。结论：SRPN在术后早期（3~6个月）能最大限度地保护患肾功能，在保护肾功能方面具有明显优势；但远期（12~24个月）随访，两种术式患侧GFR均有不同程度的下降，提示SRPN在远期保护肾功能有个体化特点；通过两种术式术后患侧GFR的比较，说明SRPN是治疗SRM的一种安全有效的手术方法，值得临床推广应用。
- 肾肿瘤 /
- 腹腔镜肾部分切除术 /
- 节段性肾动脉阻断 /
- 全肾动脉阻断
Abstract: Objective: Comparing of laparoscopic nephron-reserved partial nephrectomy with the segmental renal artery blocking(SRPN) with common laparoscopic partial nephrectomy(LPN) in effect on postoperative affected side kidney function.Method: Retrospectively collecting of 80 cases of patients with renal localised tumor from June 2010 to June 2012, 35 cases recieved SRPN, another 45 patients recieved LPN. Preoperative renal dynamic imaging and GFR, with bilateral GFR values were measured. All postoperative data were followed up by telephone per 3-6 months, which included reviewing of GFR and renal dynamic imaging, monitoring postoperative changes of bilateral GFR, and were statistical analysed.Result: After operative 3,6 months, affected side postoperative GFR comparing with preoperative GFR in SRPN were found falling in 2 of 35 cases (5.71%), 3 of 35(8.57%) respectively, and the declining GFR value were average (0.36±0.22), (3.96±1.45) ml/min respectively(P>0.05). However, that of LPN 45 cases were found in 35 of 45 cases (77.8%), 42 of 45 cases(84.4%) falling respectively, the declining average GFR value with (6.28±0.82), (11.47±3.22) ml/min respectively (P< 0.05), the rate and value of falling of affected side postoperative GFR in SRPN group vs LPN group were diferrence significantly (P< 0.05). Follwing up in postoperative 12, 18, 24 months, affected side GFR value were compared with preoperative in SRPN, GFR declining in 31.4%(11/35), 42.8%(15/35), 45.7%(16/35) respectively, falling average GRF value with (8.52±2.16), (11.02±2.23), (13.55±2.68) ml/min respectively. In LPN, postoperative affected side GFR declining 86.67%(39/45), 88.89%(40/45), 93.33%(42/45) respectively, average GFR value falling with (12.68±3.84), (17.73±4.82), (20.24±4.96) ml/min respectively. Data in SRPN vs LPN were diferrence significantly(P< 0.05).Conclusion: In early postoperative (3-6 months), SRPN can protect affected side renal function with maximizing extent and has an obvious advantage in protection of renal function vs LPN, however, in long-term following-up (12-24 months), affected side GFR in both kinds of operation have different degree to decline, the data about long-term protection of renal function in segmental renal artery block partial nephrectomy have individual characteristics. By comparing two kinds of operative methods of postoperative side GFR, SRPN is thought of a kind of safe and effective surgery method in treatment of localized renal cancer, and is worthy of clinical popularization and preferential.
- renal tumors /
- laparoscopic renal artery block /
- segmental renal artery blocking /
- localised partial nephrectomy

HTML全文

参考文献(14)

[1]	邵鹏飞, 殷长军, 孟小鑫, 等.后腹腔镜下肾部分切除术治疗肾肿瘤的疗效评价[J].中华泌尿外科杂志, 2010, 31(10):658-661.
[2]	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.
[3]	Godoy G, Ramanathan V, Kanofsky J A, et al.Effect of warm ischemia time during laparoscopic partial nephrectomy on early postoperative glomerular filtration rate[J].J Urol, 2009, 181(6):2438-2443;discussion 2443-2445.
[4]	Kutikov A, Uzzo R G.The R.E.N.A.L.nephrometry score:a comprehensive standardized system for quantitating renal tumor size, location and depth[J].J Urol, 2009, 182(3):844-853.
[5]	Choi J D, Park J W, Lee S Y, et al.Does prolonged warm ischemia after partial nephrectomy under pneumoperitoneum cause irreversible damage to the affected kidney[J]?J Urol, 2012, 187(3):802-806.
[6]	Gill I S, Kavoussi L R, Lane B R, et al.Comparison of 1, 800laparoscopic and open partial nephrectomies for single renal tumors[J].J Urol, 2007, 178(1):41-46.
[7]	邢念增, 王明帅.高选择性肾动脉分支阻断术在腹腔镜肾部分切除术中的应用[J].中华医学杂志, 2012, 92(18):1275-1277.
[8]	Gill I S, Patil M B, Abreu A L, et al.Zero ischemia anatomical partial nephrectomy:a novel approach[J].J Urol, 2012, 187(3):807-814.
[9]	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.
[10]	Thompson R H, Lane B R, 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]	Thompson R H, Lane B R, Lohse C M, et al.Renal function after partial nephrectomy:effect of warm ischemia relative to quantity and quality of preserved kidney[J].Urology, 2012, 79(2):356-360.
[12]	尚吉文, 邢念增, 闫勇, 等.Hem-o-lok结扎夹在腹腔镜肾部分切除术中的应用[J].临床泌尿外科杂志, 2008, 23(12):946-947.
[13]	朱捷, 高江平, 徐阿祥, 等.无需打结的后腹腔镜保留肾单位肾部分切除术——介绍一种快速简单的腹腔镜缝合术[J].临床泌尿外科杂志, 2010, 25(5):359-362.
[14]	Desai M M, Gill I S, Ramani A P, et al.The impact of warm ischaemia on renal function after laparoscopic partial nephrectomy[J].BJU Int, 2005, 95(3):377-383.