Application of umbrella-shaped puncture hole in laparoscopic partial nephrectomy for localized renal cell carcinoma
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摘要: 目的 探讨穿刺孔伞形布局在局限性肾癌中行后腹腔镜肾部分切除术的安全性及有效性。方法 选取2017年5月—2021年3月天津市第三中心医院收治的80例T1a期肾癌患者，均行后腹腔镜肾部分切除术。根据穿刺孔位置分为梯形布局组和伞形布局组，对其临床资料进行回顾性分析。结果 所有患者均手术成功，无中转开放患者。其中梯形布局组和伞形布局组的热缺血时间分别为(19.8±9.2) min和(15.8±7.9) min，手术时间分别为(96.9±12.5) min和(85.0±15.4) min，术中出血量分别为(86.2±22.9) mL和(73.5±17.4) mL，差异均有统计学意义(P<0.05)。2组在术后并发症发生率、术后住院天数、术后6个月患侧肾小球滤过率下降方面比较差异无统计学意义(P>0.05)。病理切缘均阴性。术后随访，梯形布局组1例复发，伞形布局组无复发。结论 穿刺孔伞形布局在后腹腔镜肾部分切除术中应用安全有效。Abstract: Objective To investigate the efficacy and safety of retroperitoneal laparoscopic partial nephrectomy with an umbrella-shaped layout for localized renal cell carcinoma.Methods A total of 80 patients with T1a stage renal cancer who were admitted to the Third Central Hospital of Tianjin from May 2017 to March 2021 were selected and underwent retroperitoneal laparoscopic partial nephrectomy. According to the position of the puncture hole, patients were divided into a trapezoidal layout group and an umbrella-shaped layout group. The clinical data were retrospectively analyzed.Results All patients underwent successful surgery, and no patients were converted to open surgery. The warm ischemia time in the trapezoidal layout group and the umbrella-shaped layout group were (19.8±9.2) min and (15.8±7.9) min, respectively, and the operation time were (96.9±12.5) min and(85.0±15.4) min, respectively. Blood loss were (86.2±22.9) mL and (73.5±17.4) mL, respectively, and the difference was statistically significant(P<0.05). There was no statistically significant difference in the postoperative complication rates, the postoperative hospitalization days and the glomerular filtration rate of the affected side decreased 6 months after operation. Pathological margins were negative. During postoperative follow-up, one patient recurred in the trapezoidal layout group, but none in the umbrella-shaped layout group.Conclusion The puncture-umbrella-shaped layout is safe and feasible in retroperitoneal laparoscopic partial nephrectomy.
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Key words:
- laparoscopy /
- partial nephrectomy /
- puncture hole /
- umbrella-shaped layout
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表 1 2组患者一般资料比较
例，X±S 项目 梯形布局组(40例) 伞形布局组(40例) t/χ2 P值 性别(男/女) 28/12 32/8 1.067 0.302 年龄/岁 58.8±9.7 61.1±11.3 -0.976 0.332 体重指数/(kg/m2) 24.0±2.0 24.2±1.2 -0.752 0.454 肿瘤位置(左/右) 20/20 26/14 1.841 0.175 肿瘤大小/cm 3.3±0.8 3.0±0.7 1.365 0.176 R.E.N.A.L.评分/分 7.0±1.7 6.5±1.2 1.457 0.149 患侧肾小球滤过率/(mL/min/1.73m2) 39.9±8.3 40.2±7.9 -0.164 0.870 
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表 2 2组患者围手术期资料比较
例(%)，X±S 项目 梯形布局组(40例) 伞形布局组(40例) t/χ2 P值 热缺血时间/min 19.8±9.2 15.8±7.9 2.035 0.045 手术时间/min 96.9±12.5 85.0±15.4 3.502 0.001 术中出血量/mL 86.2±22.9 73.5±17.4 2.786 0.007 术后并发症 0.082 0.775 ClavienⅠ级 6(15.0) 5(12.5) ClavienⅡ级 2(5.0) 2(5.0) ClavienⅢ级 0(0) 0(0) ClavienⅣ级 0(0) 0(0) 术后住院天数/d 9.1±1.9 8.9±1.8 0.605 0.547 术后6个月患侧肾小球滤过率下降量/(mL/min/1.73m2) 10.3±2.5 9.6±2.2 1.205 0.232
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