肾血流阻断方式对肾部分切除术影响的研究

康新立; 岑松; 钟江; 刘元晓; 冯雄; 王为服; 王栋; 王安方; 蔡德海; 黄卫; 陈健; 王阳; 王飞; 曾繁畅; 王忠尧; 李道源; 符厚圣; 李国平; 徐从杰; 周家权; 何峰荣; 王金刚; 徐振花

doi:10.13201/j.issn.1001-1420.2016.12.011

肾血流阻断方式对肾部分切除术影响的研究

- 1 海南省人民医院泌尿外科(海口, 570311);
- 2 东营胜利医院泌尿外科

详细信息

通讯作者: 岑松,E-mail:13876488341@qq.com

中图分类号: R699.2;R737.11

收稿日期: 2016-01-04

Research on the effect of four methods of blocking the renal blood flow on partial nephrectomy

- 1 Department of Urology, Hainan General Hospital, Haikou, 570311, China;
- 2 Department of Urology, Shengli Hospital of China Petrochemical Corporation

More Information

Corresponding author: CEN Song, E-mail: 13876488341@qq.com

Received Date: 04 January 2016

摘要

摘要: 目的:对比分析4种肾血流阻断方式对肾部分切除术的影响,探讨各术式的优劣。方法:494例肾部分切除术病例,按肾血流阻断方式分为4组。开放手术无创钳集束阻断肾蒂组(A组)129例;腹腔镜束扎带阻断肾动脉主干组(B组)203例;腹腔镜血管夹阻断肾动脉主干组(C组)94例;腹腔镜血管夹阻断肾动脉分支组(D组)68例。分别统计4组病例,达到"肿瘤切缘阴性、无肾功能降低和无泌尿外科并发症"三个技术指标的占比,对比各组差异。肾功能降低的标准,是术后实测的eGFR,小于用残肾体积估算的eGFR。结果:4组病例,肿瘤RENAL评分分别为9.3、9.2、9.1和9.5(P=0.07);肿瘤切缘阳性率均低于1%。保留残肾体积百分比,分别为88%、89%、90%和87%(P=0.1),术后实测eGFR比估算eGFR降低,分别为9.5%、11%、4.2%和6.9%(P＜0.001)。泌尿外科并发症,分别6%、10%、5%和13%(P=0.01)。同时达到三个技术指标,分别为45%、44%、69%和62%(P=0.002)。结论:肾部分切除术中肾血流阻断,单独阻断肾动脉优于集束阻断肾蒂,阻断肾动脉主干优于阻断分支,阻断肾动脉血管夹优于束扎带。
- 肾脏 /
- 肾血流 /
- 肾肿瘤 /
- 肾部分切除术 /
- 腹腔镜
Abstract: Objective: To compare the advantages and disadvantages among four methods of blocking the renal blood flow in partial nephrectomy (PN).Method: A total of 494 patients had complete data available and were retrospectively divided into four groups according to different methods of blocking renal blood flow. Group A (129 cases) underwent open surgery with the renal hilar blocking by atrauma artery forceps. Group B (203 cases) underwent laparoscopic PN with renal artery blocking by a ligated tape. Group C (94 cases) also underwent laparoscopic PN with renal artery blocking by John Hopkin's bulldog clamp. Group D (68 cases) underwent laparoscopic PN with renal artery branches blocking by bulldog clamp. We analyzed the proportion of three-key-goal outcomes among each group, including outcomes of negative cancer margin, minimal renal functional decrease and no urological complications. Renal functional decrease was defined as a greater than percent of loss partial volume reduction in the actual vs volume predicted postoperative estimated glomerular filtration rate (eGFR).Result: RENAL score of four groups were 9.3, 9.2, 9.1 and 9.5 respectively (P=0.07), which showd no significant difference. Positive cancer margins were all less than 1%. Also, the estimated percent of kidney preserved was similar (88%, 89%, 90% and 87%, respectively, P=0.1). Actual eGFR outcomes vs predicted eGFR outcomes decreased 9.5%, 11%, 4.2% and 6.9% respectively (P＜0.001). The incidence of urological complications were 6%, 10%, 5% and 13% respectively (P=0.01). Three-key-goal outcomes had realized up to 45%, 44%, 69% and 62%, respectively (P=0.002).Conclusion: For the laparoscopic PN, it's the best method to block the renal artery by John Hopkin's bulldog clamp compared to others, especially blocking the renal artery branches.
- kidney /
- renal blood flow /
- renal carcinoma /
- partial nephrectomy /
- laparoscope

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