中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2011年
5期
303-306
,共4页
肾肿瘤%肾部分切除术%热缺血%肾功能%肾小球滤过率
腎腫瘤%腎部分切除術%熱缺血%腎功能%腎小毬濾過率
신종류%신부분절제술%열결혈%신공능%신소구려과솔
Kidney neoplasms%Partial nephrectomy%Warm ischemia%Renal function%Glomerular filtration rate
目的 评价肾部分切除术治疗肾肿瘤的安全性及有效性.方法 回顾性分析56例行肾部分切除术患者的临床资料.术中肾动脉阻断时间≤30 min者28例.＞30 min者28例.采用99Tcm-DTPA肾核素扫描检测术前术后分肾的肾小球滤过率(GFR),比较两组患者术中出血量、手术时间、术后住院日、并发症发生率以及术前、术后1周和术后6个月的GFR值,明确肾热缺血安全时限,并随访远期生存情况.结果 术后随访30～48个月,平均36个月,总体生存率和肿瘤无复发生存率分别为100%和98%.阻断时间≤30 min和＞30 min组患者术中失血量、手术时间、术后住院日及并发症比较,差异均无统计学意义(P＞0.05).两组术前患肾GFR分别为(42.9±4.9)、(42.8±5.6)ml/min,术后1周为(34.2±4.9)和(30.4±5.2)ml/min,前者GFR降低程度低于后者,差异有统计学意义(p=0.007).术后6个月时肾热缺血时间≤30 min组患肾GFR为(41.2±4.3)ml/min,与术前相比,差异无统计学意义(P＞0.05);＞30 min组GFR为(38.1±5.0)ml/min,仍明显低于术前水平(P=0.001).结论 肾部分切除术治疗肾肿瘤局部复发率低,远期生存率高,并发症发生率低,而且能最大限度地保留功能性肾单位,安全有效.术中阻断肾血管可以有效减少术中失血,将热缺血时间控制在30 min内,对肾功能影响较小,安全可行.
目的 評價腎部分切除術治療腎腫瘤的安全性及有效性.方法 迴顧性分析56例行腎部分切除術患者的臨床資料.術中腎動脈阻斷時間≤30 min者28例.＞30 min者28例.採用99Tcm-DTPA腎覈素掃描檢測術前術後分腎的腎小毬濾過率(GFR),比較兩組患者術中齣血量、手術時間、術後住院日、併髮癥髮生率以及術前、術後1週和術後6箇月的GFR值,明確腎熱缺血安全時限,併隨訪遠期生存情況.結果 術後隨訪30～48箇月,平均36箇月,總體生存率和腫瘤無複髮生存率分彆為100%和98%.阻斷時間≤30 min和＞30 min組患者術中失血量、手術時間、術後住院日及併髮癥比較,差異均無統計學意義(P＞0.05).兩組術前患腎GFR分彆為(42.9±4.9)、(42.8±5.6)ml/min,術後1週為(34.2±4.9)和(30.4±5.2)ml/min,前者GFR降低程度低于後者,差異有統計學意義(p=0.007).術後6箇月時腎熱缺血時間≤30 min組患腎GFR為(41.2±4.3)ml/min,與術前相比,差異無統計學意義(P＞0.05);＞30 min組GFR為(38.1±5.0)ml/min,仍明顯低于術前水平(P=0.001).結論 腎部分切除術治療腎腫瘤跼部複髮率低,遠期生存率高,併髮癥髮生率低,而且能最大限度地保留功能性腎單位,安全有效.術中阻斷腎血管可以有效減少術中失血,將熱缺血時間控製在30 min內,對腎功能影響較小,安全可行.
목적 평개신부분절제술치료신종류적안전성급유효성.방법 회고성분석56례행신부분절제술환자적림상자료.술중신동맥조단시간≤30 min자28례.＞30 min자28례.채용99Tcm-DTPA신핵소소묘검측술전술후분신적신소구려과솔(GFR),비교량조환자술중출혈량、수술시간、술후주원일、병발증발생솔이급술전、술후1주화술후6개월적GFR치,명학신열결혈안전시한,병수방원기생존정황.결과 술후수방30～48개월,평균36개월,총체생존솔화종류무복발생존솔분별위100%화98%.조단시간≤30 min화＞30 min조환자술중실혈량、수술시간、술후주원일급병발증비교,차이균무통계학의의(P＞0.05).량조술전환신GFR분별위(42.9±4.9)、(42.8±5.6)ml/min,술후1주위(34.2±4.9)화(30.4±5.2)ml/min,전자GFR강저정도저우후자,차이유통계학의의(p=0.007).술후6개월시신열결혈시간≤30 min조환신GFR위(41.2±4.3)ml/min,여술전상비,차이무통계학의의(P＞0.05);＞30 min조GFR위(38.1±5.0)ml/min,잉명현저우술전수평(P=0.001).결론 신부분절제술치료신종류국부복발솔저,원기생존솔고,병발증발생솔저,이차능최대한도지보류공능성신단위,안전유효.술중조단신혈관가이유효감소술중실혈,장열결혈시간공제재30 min내,대신공능영향교소,안전가행.
Objective To report the safety and efficacy of partial nephrectomy (PN) in 56 patients with renal tumors. Methods A retrospective analysis was performed for 56 patients who were treated with PN.Patients were divided into two groups according to the occlusion time.The occlusion time for Group 1 was≤30 min in 28 cases,and Group 2＞30 min in 28 cases.All patients underwent pre-and post-operation 99Tcm-diethylenetriamine pentoacetic acid renal scintigraphy, to determine the renal glomerular filtration rate (GFR).The GFR values, amount of blood loss during operation,operative time,postoperative hospital stay and the complications rate were compared between the two groups prior to surgery and one week and six months post-surgery.All patients were followed-up.Results The average follow-up time was 36 (30-48) months.The overall survival rate and tumor recurrence-free survival rate were 100% and 98%.There was no significant difference between vessel clamp time≤30 min and＞30 min in the amount of intraoperative blood loss,operative time,postoperative hospital stay and complications rate,P values were 0.266,0.487,0.879 and 1.000.The preoperative and 1 week postoperative GFR values of the two groups were (42.9±4.9) and (34.2±4.9),(42.8±5.6) and (30.4±5.2) ml/min.The difference was significant(P=0.007).The GFR values were (41.2±4.3)ml/min at 6 months after surgery for Group 1,compared with that before surgery,but the difference was not significant (P＞0.05).While the GFR values were (38.1±5.0) ml/min for Group 2,and the GFR for Group 2 did not recover to the preoperative level (P=0.001). Conelusions PN for renal tumors could be a safe and effective treatment option.The damage on renal function could be minimal when the renal artery clamping time is controlled to within 30 min.
