Application value of 3D visualization reconstruction combined with perirenal ice water technique in laparoscopic partial nephrectomy
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摘要: 目的 探讨三维可视化重建联合肾周冰水降温技术在肾肿瘤患者行腹腔镜肾部分切除术(laparoscopic partial nephrectomy，LPN)中的应用价值。方法 回顾性分析2020年1月—2022年7月于绍兴市中心医院因肾肿瘤行LPN的46例患者临床资料。根据是否采用三维可视化重建联合肾周冰水降温技术，将患者分为观察组(行三维可视化重建联合肾周冰水降温技术，21例)和对照组(未行三维可视化重建联合肾周冰水降温技术，25例)，采用调查问卷形式记录术前谈话评分，比较2组手术时间、肾缺血时间、术中出血量、术后胃肠功能恢复时间、留置导尿时间、留置引流管时间、住院时间、术后1 d与3个月血肌酐值及上升百分比、术后1 d与3个月估算肾小球滤过率值(eGFR)及下降百分比。结果 46例患者均顺利完成手术，无中转开放、输血及严重并发症。观察组和对照组术前谈话评分分别为(7.6±0.9)分和(6.4±1.0)分，手术时间分别为(132.5±15.3) min和(148.5±15.6) min，肾缺血时间分别为(24.9±1.5) min和(26.4±2.3) min，术后1 d血肌酐上升百分比分别为(14.0±3.9)%和(20.3±5.9)%，术后3个月血肌酐上升百分比分别为(8.5±4.7)%和(15.0±3.5)%，术后1 d eGFR下降百分比分别为(13.9±3.4)%和(19.0±4.4)%，术后3个月eGFR下降百分比分别为(8.8±4.5)%和(14.8±3.0)%，差异均有统计学意义(P < 0.05)。2组患者术中出血量、术后胃肠功能恢复时间、留置导尿时间、留置引流管时间、住院时间、术后1 d及3个月血肌酐值、术后1 d及3个月eGFR比较，差异均无统计学意义(P>0.05)。结论 三维可视化重建联合肾周冰水降温技术可以改善LPN术前医患沟通，缩短手术时间及肾缺血时间，减少缺血导致的肾功能损伤，保护术后肾功能，值得临床推广应用。Abstract: Objective To investigate the application value of 3D visualization reconstruction combined with perirenal ice water cooling in laparoscopic partial nephrectomy(LPN) for patients with renal tumor.Methods The clinical data of 46 patients who underwent LPN for renal tumor from January 2020 to July 2022 in Shaoxing Central Hospital were retrospectively analyzed. According to whether 3D visualization reconstruction and perirenal ice water cooling technology was used, the patients were divided into observation group(receiving 3D visualization reconstruction and perirenal cooling technology, 21 cases) and control group(not receiving 3D visualization reconstruction and perirenal cooling technology, 25 cases). The preoperative communication score was recorded by questionnaire. The operative time, renal ischemia time, intraoperative blood loss, postoperative gastrointestinal function recovery time, drainage tube removal time, catheter removal time, hospital stay, serum creatinine value and the increase percentage at 1 day and 3 months after surgery, estimated glomerular filtration rate(eGFR) value and decrease percentage at 1 day and 3 months after surgery were compared between the two groups.Results Forty-six patients were successfully completed the operation without conversion to open, blood transfusion or serious complications. The preoperative communication score of the observation group was significantly higher than that of the control group ([7.6±0.9] points vs[6.4±1.0] points, P < 0.05). The operative time and the renal ischemia time of the observation group were significantly shorter than those of the control group([132.5±15.3] min vs [148.5±15.6] min, [24.9±1.5] min vs [26.4±2.3] min, P < 0.05). The increase percentage of serum creatinine at 1 day and 3 months after surgery of the observation group were significantly less than those of the control group([14.0±3.9]% vs [20.3±5.9]%, [8.5±4.7]% vs [15.0±3.5]%, P < 0.05). The decrease percentage of eGFR at 1 day and 3 months after surgery of the observation group were significantly less than those of the control group([13.9±3.4]% vs [19.0±4.4]%, [8.8±4.5]% vs [14.8±3.0]%, P < 0.05). However, there were no significant differences in intraoperative blood loss, postoperative gastrointestinal function recovery time, drainage tube removal time, catheter removal time, hospital stay, serum creatinine value or eGFR at 1 day and 3 months after surgery between the two groups.Conclusion Three-dimensional visualization reconstruction combined with perirenal ice water cooling technology can improve doctor-patient communication before LPN, reduce operation time, renal ischemia time, and renal injury caused by ischemia, and protect postoperative renal function, so it is worthy of clinical application.
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表 1 2组患者一般临床资料比较
例，X±S 项目 观察组(21例) 对照组(25例) t/χ2 P值 年龄/岁 56.5±10.6 54.3±12.1 0.651 0.518 性别 1.618 0.203 男 17 16 女 4 9 BMI/(kg/m2) 24.9±2.3 25.2±2.8 -0.315 0.755 既往腹部手术史 12 13 0.122 0.727 ASA分级/级 1.7±0.5 1.8±0.4 -1.000 0.324 肿瘤直径/cm 3.9±1.2 3.6±1.3 0.838 0.407 肿瘤位置 0.088 0.767 左侧 10 13 右侧 11 12 R.E.N.A.L.评分/分 7.1±1.5 6.9±1.7 0.467 0.643 手术入路 0.378 0.539 经腰入路 5 8 经腹入路 16 17 术前肌酐/(μmol/L) 75.5±15.5 78.5±17.5 -0.602 0.550 术前eGFR/[mL/(min·1.73m2)] 98.4±23.8 92.7±32.5 0.664 0.510 
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表 2 2组患者围手术期指标比较
X±S 指标 观察组 对照组 t/χ2 P值 术前谈话评分 7.6±0.9 6.4±1.0 4.469 < 0.001 肾肿瘤了解程度 2.6±0.5 2.1±0.6 3.056 0.004 手术过程了解程度 2.5±0.5 2.1±0.6 2.429 0.019 手术并发症了解程度 2.5±0.5 2.2±0.6 1.996 0.052 肾缺血时间/min 24.9±1.5 26.4±2.3 -2.767 0.008 手术时间/min 132.5±15.3 148.5±15.6 -3.493 0.001 出血量/mL 126.7±25.8 135.2±34.0 -0.943 0.351 术后胃肠功能恢复时间/d 1.7±0.7 1.8±0.8 -0.628 0.534 术后留置导尿时间/d 2.3±0.6 2.6±0.6 -1.560 0.126 术后引流管留置时间/d 3.6±1.1 3.7±1.2 -0.323 0.748 术后住院时间/d 6.2±1.2 6.4±1.3 -0.464 0.645 术后1 d肌酐/(μmol/L) 86.2±18.9 94.4±21.7 -1.352 0.183 术后1 d肌酐上升百分比/% 14.0±3.9 20.3±5.9 -4.155 < 0.001 术后3个月肌酐/(μmol/L) 82.0±17.3 90.1±19.8 -1.468 0.149 术后3个月肌酐上升百分比/% 8.5±4.7 15.0±3.5 -5.379 < 0.001 术后1 d eGFR/[mL/(min·1.73 m2)] 85.0±21.7 75.1±26.1 1.385 0.173 术后1 d eGFR下降百分比/% 13.9±3.4 19.0±4.4 -4.300 < 0.001 术后3个月eGFR/[mL/(min·1.73 m2)] 89.9±23.4 78.8±26.7 1.492 0.143 术后3个月eGFR下降百分比/% 8.8±4.5 14.8±3.0 -5.203 < 0.001
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