CAJ | 학술논문

目的探讨氩气刀在腹腔镜下小肾癌剜除术中应用的可行性及疗效. 方法使用氩气刀对家兔肾部分切除刨面行凝固治疗.日本大耳兔16只,体质量2～3 kg,随机分为4组,每组4只.组1、2:未阻断肾蒂,氩气刀创面凝固治疗时间分别约4、6 s;组3、4:阻断肾蒂,氩气刀创面凝固治疗时间分别约2、4 s.术后3周镜下观察肾脏创缘处肾脏组织结构、坏死及瘢痕形成情况.2006年6月至2008年10月行腹腔镜下小肾癌剜除后氩气刀创面凝固治疗10例.患者术前双肾CT平扫均可见肾上极、下极或外侧实性外凸型占位,强化后可见CT值明显增高,肿瘤直径1.5～3.5cm. 结果 16只家兔手术均获成功.术后组织学检查示坏死区域出现钙化,焦痂区组织致密,与肾脏组织之间见成熟肉芽组织,形成纤维结缔组织.4组肾脏凝固治疗后坏死深度分别为(2.76±0.17)、(3.15±0.15)、(2.28±0.16)、(2.75±0.06)cm,组1、4与组2、3比较差异均有统计学意义(P＜0.05),组1、4比较差异无统计学意义(P＞0.05).10例肾癌剜除术均获成功,手术时间平均163(100～210)min,平均术中出血230(100～400)ml.1例术后对止血纱布过敏,1个月后拔除引流管.余9例术后引流3～5 d.术后平均随访22(10～38)个月,均未见局部肿瘤复发及远处转移.结论腹腔镜下小肾癌剜除后创面氩气刀凝固治疗是一种可行的治疗方式.
목적 탐토아기도재복강경하소신암완제술중응용적가행성급료효. 방법 사용아기도대가토신부분절제포면행응고치료.일본대이토16지,체질량2～3 kg,수궤분위4조,매조4지.조1、2:미조단신체,아기도창면응고치료시간분별약4、6 s;조3、4:조단신체,아기도창면응고치료시간분별약2、4 s.술후3주경하관찰신장창연처신장조직결구、배사급반흔형성정황.2006년6월지2008년10월행복강경하소신암완제후아기도창면응고치료10례.환자술전쌍신CT평소균가견신상겁、하겁혹외측실성외철형점위,강화후가견CT치명현증고,종류직경1.5～3.5cm. 결과 16지가토수술균획성공.술후조직학검사시배사구역출현개화,초가구조직치밀,여신장조직지간견성숙육아조직,형성섬유결체조직.4조신장응고치료후배사심도분별위(2.76±0.17)、(3.15±0.15)、(2.28±0.16)、(2.75±0.06)cm,조1、4여조2、3비교차이균유통계학의의(P＜0.05),조1、4비교차이무통계학의의(P＞0.05).10례신암완제술균획성공,수술시간평균163(100～210)min,평균술중출혈230(100～400)ml.1례술후대지혈사포과민,1개월후발제인류관.여9례술후인류3～5 d.술후평균수방22(10～38)개월,균미견국부종류복발급원처전이.결론 복강경하소신암완제후창면아기도응고치료시일충가행적치료방식.
Objective To evaluate the feasibility and clinical effect of Argon plasma coagulator in simple enucleation for small renal cell carcinoma. Methods On the basis of successful performing the animal experience of coagulating therapy on the wound tissue during partial nephrectomy with Argon plasma coagulator in rabbit models, 10 cases of simple enucleation for small renal cell carcinoma with Argon plasma coagulator were accomplished. Results Both with the standard of stopping bleeding of wound tissue by Argon plasma coagulator and with the standard of re-spraying the wound tissue for 2 s after stopping bleeding using Argon plasma coagulator, the depth of wound tissue necrosis without blocking the renal pedicle is deeper than that with blocking the renal pedicle(P=0. 012 and P=0. 002, respectively).If the wound tissue was re-sprayed for 2 s after stopping bleeding by Argon plasma coagulator, the depth of the wound tissue necrosis without blocking the renal pedicle was deeper than that just with blocking the renal pedicle(P=0. 007 and P=0. 002,respectively). In the part of application in clinical, all procedures were successfully completed. The mean operative time was 163 min (range, 100-210 min) and mean blood loss was 230 ml (range, 100-400 ml). Drainage tube was pulled out 1 month after operation in 1 case for being allergic to absorbable hemostatic gauze, and the mean pulling drainage tube out time in others was 4. 2 d (range, 3-5 d). During a mean follow-up of 22 months (range, 10-38 months), no local tumor recurrence and distant metastasis was found. Conclusion Argon plasma coagulator can be used in simple enucleation for small renal cell carcinoma, and the clinical effectiveness is ideal.