中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2012年
1期
51-54
,共4页
温海涛%周克文%朱伟智%杜洲舸%姚许平
溫海濤%週剋文%硃偉智%杜洲舸%姚許平
온해도%주극문%주위지%두주가%요허평
肾肿瘤%肾部分切除%腹腔镜%射频消融
腎腫瘤%腎部分切除%腹腔鏡%射頻消融
신종류%신부분절제%복강경%사빈소융
Renal tumor%Partial Nephrectomy%Laparoscopy%Radiofrequency ablation
目的 探讨Habib 4X双极射频辅助无肾动脉阻断腹腔镜肾部分切除术的临床效果.方法 2010年10月至2011年6月采用Habib 4X双极射频辅助腹腔镜肾部分切除术(laparoscopic partial nephrectomy with radiofrequency ablation,LRA)和腹腔镜肾部分切除术(laparoscopic partial nephrectomy,LPN)治疗肾肿瘤(T1N0M0)患者14例,肿瘤均为外向型生长.LRA组6例,男4例,女2例；年龄38 ～75岁,平均60岁；肿瘤位于左肾3例,右肾3例；肾上极2例、中极2例、下极2例；肿瘤最大径2.1 ～3.5 cm,平均3.1 cm.LPN组8例,男4例,女4例；年龄36 ～ 77岁,平均61岁；肿瘤位于左肾3例,右肾5例；肾上极3例、中极2例、下极3例；肿瘤最大径2.0～3.7 cm,平均3.0 cm.记录手术时间、术中出血量、术后住院时间、术后并发症等指标,比较手术前后Hb、SCr、患侧肾小球滤过率(glomeruar filtration rate,GFR)的变化. 结果 14例手术均获成功,无中转开放手术者.LRA组无需阻断肾蒂,手术前后Hb、SCr、患侧GFR比较分别为(127±19)和(124±19) g/L、(96 ±39)和(92±29) μmol/L、(42±12)和(40±13) ml/min,差异均无统计学意义(P＞0.05).LPN组术中阻断肾动脉20 ～ 52 min,平均31.5 min.手术前后Hb、SCr、患侧GFR分别为(130 ±17)和(112±15) g/L,(92 ±31)和(110±28)μmol/L,(43 ±14)和(30 ±11)ml/min,差异均有统计学意义(P＜0.05).LRA组和LPN组手术时间分别为(86±20)min、(112 ±43)min,术中出血量分别为(94±18) ml、(256 ±58)ml,术后住院时间分别为(5.0±0.8)d、(7.8±1.2)d,组间比较差异均有统计学意义(P＜0.05).LRA组术后无出血、肉眼血尿和漏尿等并发症. 结论 Habib 4X双极射频辅助腹腔镜无肾动脉阻断肾部分切除术治疗肾肿瘤安全有效,在手术时间、术中出血量和术后恢复等方面均优于LPN.
目的 探討Habib 4X雙極射頻輔助無腎動脈阻斷腹腔鏡腎部分切除術的臨床效果.方法 2010年10月至2011年6月採用Habib 4X雙極射頻輔助腹腔鏡腎部分切除術(laparoscopic partial nephrectomy with radiofrequency ablation,LRA)和腹腔鏡腎部分切除術(laparoscopic partial nephrectomy,LPN)治療腎腫瘤(T1N0M0)患者14例,腫瘤均為外嚮型生長.LRA組6例,男4例,女2例；年齡38 ～75歲,平均60歲；腫瘤位于左腎3例,右腎3例；腎上極2例、中極2例、下極2例；腫瘤最大徑2.1 ～3.5 cm,平均3.1 cm.LPN組8例,男4例,女4例；年齡36 ～ 77歲,平均61歲；腫瘤位于左腎3例,右腎5例；腎上極3例、中極2例、下極3例；腫瘤最大徑2.0～3.7 cm,平均3.0 cm.記錄手術時間、術中齣血量、術後住院時間、術後併髮癥等指標,比較手術前後Hb、SCr、患側腎小毬濾過率(glomeruar filtration rate,GFR)的變化. 結果 14例手術均穫成功,無中轉開放手術者.LRA組無需阻斷腎蒂,手術前後Hb、SCr、患側GFR比較分彆為(127±19)和(124±19) g/L、(96 ±39)和(92±29) μmol/L、(42±12)和(40±13) ml/min,差異均無統計學意義(P＞0.05).LPN組術中阻斷腎動脈20 ～ 52 min,平均31.5 min.手術前後Hb、SCr、患側GFR分彆為(130 ±17)和(112±15) g/L,(92 ±31)和(110±28)μmol/L,(43 ±14)和(30 ±11)ml/min,差異均有統計學意義(P＜0.05).LRA組和LPN組手術時間分彆為(86±20)min、(112 ±43)min,術中齣血量分彆為(94±18) ml、(256 ±58)ml,術後住院時間分彆為(5.0±0.8)d、(7.8±1.2)d,組間比較差異均有統計學意義(P＜0.05).LRA組術後無齣血、肉眼血尿和漏尿等併髮癥. 結論 Habib 4X雙極射頻輔助腹腔鏡無腎動脈阻斷腎部分切除術治療腎腫瘤安全有效,在手術時間、術中齣血量和術後恢複等方麵均優于LPN.
목적 탐토Habib 4X쌍겁사빈보조무신동맥조단복강경신부분절제술적림상효과.방법 2010년10월지2011년6월채용Habib 4X쌍겁사빈보조복강경신부분절제술(laparoscopic partial nephrectomy with radiofrequency ablation,LRA)화복강경신부분절제술(laparoscopic partial nephrectomy,LPN)치료신종류(T1N0M0)환자14례,종류균위외향형생장.LRA조6례,남4례,녀2례；년령38 ～75세,평균60세；종류위우좌신3례,우신3례；신상겁2례、중겁2례、하겁2례；종류최대경2.1 ～3.5 cm,평균3.1 cm.LPN조8례,남4례,녀4례；년령36 ～ 77세,평균61세；종류위우좌신3례,우신5례；신상겁3례、중겁2례、하겁3례；종류최대경2.0～3.7 cm,평균3.0 cm.기록수술시간、술중출혈량、술후주원시간、술후병발증등지표,비교수술전후Hb、SCr、환측신소구려과솔(glomeruar filtration rate,GFR)적변화. 결과 14례수술균획성공,무중전개방수술자.LRA조무수조단신체,수술전후Hb、SCr、환측GFR비교분별위(127±19)화(124±19) g/L、(96 ±39)화(92±29) μmol/L、(42±12)화(40±13) ml/min,차이균무통계학의의(P＞0.05).LPN조술중조단신동맥20 ～ 52 min,평균31.5 min.수술전후Hb、SCr、환측GFR분별위(130 ±17)화(112±15) g/L,(92 ±31)화(110±28)μmol/L,(43 ±14)화(30 ±11)ml/min,차이균유통계학의의(P＜0.05).LRA조화LPN조수술시간분별위(86±20)min、(112 ±43)min,술중출혈량분별위(94±18) ml、(256 ±58)ml,술후주원시간분별위(5.0±0.8)d、(7.8±1.2)d,조간비교차이균유통계학의의(P＜0.05).LRA조술후무출혈、육안혈뇨화루뇨등병발증. 결론 Habib 4X쌍겁사빈보조복강경무신동맥조단신부분절제술치료신종류안전유효,재수술시간、술중출혈량화술후회복등방면균우우LPN.
Objective To explore the clinical effect of Habib 4X bipolar radiofrequency ablation assisted laparoscopic partial nephrectomy without blockage of renal artery for treatment of renal cell carcinoma (RCC). Methods Between October 2010 and June 2011, 14 patients with exophytic RCC (T1N0M0) were treated with Laparoscopic Partial Nephrectomy with (LRA) or without (LPN) Habib 4X Bipolar Radiofrequency ablation assisted.The LRA group included 6 patients,and the maximum tumor diameter was 2.1 - 3.5 cm (mean,3.1 cm).The LPN group included 8 patients,and the maximum tumor diameter was 2.0 -3.7 cm (mean,3.0 cm).The operative time,average intra-operative blood loss,postoperative hospital stay and incidence of postoperative complications were recorded.Changes of hemoglobin (Hb),serum creatinine (SCr) and ipsilateral glomerular filtration rate (GFR) before and after operation were analyzed and compared. Results The 14 surgical procedures were successful without conversion to open operation.In LRA group,renal artery blocking was unnecessary,the Hb,SCr and GFR before and after operation were (127 ± 19) g/L vs.(124 ± 19) g/L、(96 ±39) μmol/L vs.(92 ±29) μmol/L and (42 ± 12) ml/min vs.(40 ± 13) ml/min,respectively,and the difference was not significant (P ＞0.05).In LPN group,the renal artery blocking time was 20-52 min (mean,32 min),the Hb,SCr and GFR before and after operations were (130±17) g/L vs.(112±15) g/L,(92 ±31) μ mol/L vs.(110±28)μmol/L and (43 ± 14) ml/min vs.(30 ± 11 ) ml/min respectively,and the difference was significant (P ＜0.05 ).The operative time was ( 86 ± 20) min and ( 112 ± 43 ) min,the estimated blood loss was (94 ± 18)ml and (256 ± 58) ml,and the postoperative hospital stay was (5.0 ± 0.8) d and (7.8 ± 1.2 ) d,respectively.The difference between the two groups was significant (P ＜ O.05).Complications such as bleeding,gross hematuria,and leakage of urine were noted in LRA group. Conclusions Habib 4X Bipolar Radiofrequency ablation assisted LPN without blockage of renal artery is a safe and effective intervention with a relatively low incidence of complications.And it is superior to LPN in operative time,intraoperative blood loss and postoperative recovery.
