临床肿瘤学杂志
臨床腫瘤學雜誌
림상종류학잡지
CHINESE CLINICAL ONCOLOGY
2014年
4期
338-341
,共4页
龚隽%许传亮%任善成%葛京平%魏武%杨斌%孙颖浩
龔雋%許傳亮%任善成%葛京平%魏武%楊斌%孫穎浩
공준%허전량%임선성%갈경평%위무%양빈%손영호
肾癌%后腹腔镜%肾部分切除术%选择性肾动脉阻断
腎癌%後腹腔鏡%腎部分切除術%選擇性腎動脈阻斷
신암%후복강경%신부분절제술%선택성신동맥조단
Renal cell carcinoma%Retroperitoneal laparoscopic%Partial nephrectomy%Selective renal artery clamping
目的:探讨后腹腔镜下肾部分切除术( RLPN)的不同术式治疗早期肾癌的有效性及安全性。方法回顾性分析2006年2月至2012年12月我院收治的肿瘤最大径<4cm,并行RLPN的肾癌患者127例。分为4组,传统组( n=44)以传统肾肿瘤剜除术治疗,假包膜组( n=35)为单纯沿肿瘤假包膜切除肿瘤,免打结组( n=39)为沿肿瘤假包膜切除肿瘤并采用免打结缝合修补肾脏组织缺损,选择性阻断组( n=9)在免打结技术的基础上对肾动脉选择性阻断并切断肿瘤血供。比较前3组肾蒂血管阻断时间、手术时间、术中出血量、术后住院天数、术中输血率及术后尿漏发生率。结果3组的肾蒂血管阻断时间分别为(32?07±5?59)min、(30?20±5?84)min、(27?31±6?17)min,差异有统计学意义(P=0?002);3组的手术时间分别为(109?68±20?07)min、(106?20±16?32)min、(97?00±17?65)min,差异有统计学意义(P=0?007);3组的术中出血量分别为(106?93±72?26)ml、(80?26±49?57)ml、(54?23±36?32)ml,差异有统计学意义(P=0?000);3组的术后住院天数分别为(7?82±1?42)d、(6?31±1?69)d、(5?97±1?51)d,差异有统计学意义(P=0?000);3组术中输血率分别为2?3%(1/44)、0(0/35)及0(0/39),差异无统计学意义( P>0?05);3组术后尿漏发生率分别为0(0/44)、2?9%(1/35)及2?6%(1/39),差异无统计学意义( P>0?05)。术后随访14~60个月,127例患者均无复发或转移。结论对于较小的肾癌,沿包膜剜除肾肿瘤及术中免打结技术的应用明显缩短了肾动脉的阻断时间及术中出血量。同时,选择性肾动脉阻断技术的应用将有望摆脱肾蒂阻断时间及热缺血时间的限制,值得进一步研究。
目的:探討後腹腔鏡下腎部分切除術( RLPN)的不同術式治療早期腎癌的有效性及安全性。方法迴顧性分析2006年2月至2012年12月我院收治的腫瘤最大徑<4cm,併行RLPN的腎癌患者127例。分為4組,傳統組( n=44)以傳統腎腫瘤剜除術治療,假包膜組( n=35)為單純沿腫瘤假包膜切除腫瘤,免打結組( n=39)為沿腫瘤假包膜切除腫瘤併採用免打結縫閤脩補腎髒組織缺損,選擇性阻斷組( n=9)在免打結技術的基礎上對腎動脈選擇性阻斷併切斷腫瘤血供。比較前3組腎蒂血管阻斷時間、手術時間、術中齣血量、術後住院天數、術中輸血率及術後尿漏髮生率。結果3組的腎蒂血管阻斷時間分彆為(32?07±5?59)min、(30?20±5?84)min、(27?31±6?17)min,差異有統計學意義(P=0?002);3組的手術時間分彆為(109?68±20?07)min、(106?20±16?32)min、(97?00±17?65)min,差異有統計學意義(P=0?007);3組的術中齣血量分彆為(106?93±72?26)ml、(80?26±49?57)ml、(54?23±36?32)ml,差異有統計學意義(P=0?000);3組的術後住院天數分彆為(7?82±1?42)d、(6?31±1?69)d、(5?97±1?51)d,差異有統計學意義(P=0?000);3組術中輸血率分彆為2?3%(1/44)、0(0/35)及0(0/39),差異無統計學意義( P>0?05);3組術後尿漏髮生率分彆為0(0/44)、2?9%(1/35)及2?6%(1/39),差異無統計學意義( P>0?05)。術後隨訪14~60箇月,127例患者均無複髮或轉移。結論對于較小的腎癌,沿包膜剜除腎腫瘤及術中免打結技術的應用明顯縮短瞭腎動脈的阻斷時間及術中齣血量。同時,選擇性腎動脈阻斷技術的應用將有望襬脫腎蒂阻斷時間及熱缺血時間的限製,值得進一步研究。
목적:탐토후복강경하신부분절제술( RLPN)적불동술식치료조기신암적유효성급안전성。방법회고성분석2006년2월지2012년12월아원수치적종류최대경<4cm,병행RLPN적신암환자127례。분위4조,전통조( n=44)이전통신종류완제술치료,가포막조( n=35)위단순연종류가포막절제종류,면타결조( n=39)위연종류가포막절제종류병채용면타결봉합수보신장조직결손,선택성조단조( n=9)재면타결기술적기출상대신동맥선택성조단병절단종류혈공。비교전3조신체혈관조단시간、수술시간、술중출혈량、술후주원천수、술중수혈솔급술후뇨루발생솔。결과3조적신체혈관조단시간분별위(32?07±5?59)min、(30?20±5?84)min、(27?31±6?17)min,차이유통계학의의(P=0?002);3조적수술시간분별위(109?68±20?07)min、(106?20±16?32)min、(97?00±17?65)min,차이유통계학의의(P=0?007);3조적술중출혈량분별위(106?93±72?26)ml、(80?26±49?57)ml、(54?23±36?32)ml,차이유통계학의의(P=0?000);3조적술후주원천수분별위(7?82±1?42)d、(6?31±1?69)d、(5?97±1?51)d,차이유통계학의의(P=0?000);3조술중수혈솔분별위2?3%(1/44)、0(0/35)급0(0/39),차이무통계학의의( P>0?05);3조술후뇨루발생솔분별위0(0/44)、2?9%(1/35)급2?6%(1/39),차이무통계학의의( P>0?05)。술후수방14~60개월,127례환자균무복발혹전이。결론대우교소적신암,연포막완제신종류급술중면타결기술적응용명현축단료신동맥적조단시간급술중출혈량。동시,선택성신동맥조단기술적응용장유망파탈신체조단시간급열결혈시간적한제,치득진일보연구。
Objective To investigate the efficacy and safety of different surgical treatment of retroperitoneal laparoscopic partial ne-phrectomy for patients with localized renal cell carcinoma. Methods 127 patients with tumor size<4cm underwent RLPN from February 2006 to December 2012 in our hospital. According to the course of the new surgical techniques adopted, they were divided into 4 groups:conven-tional group(n=44), simple enucleation group(n=35), knot-free suture group(n=39)and selective artery clamping group(n=9). The data of operative time, renal artery clamping time, blood loss during operation, postoperative hospital stay, intraoperative transfusion rate and the incidence of urinary leakage postoperation were collected, and those data of the former three groups were statistical analyzed. Results The mean time of renal artery clamping in the former three groups was(32?07±5?59)min,(30?20±5?84)min,(27?31±6?17)min,respectively. The mean operative time were(109?68±20?07)min,(106?20±16?32)min,(97?00±17?65)min,respectively. The mean blood loss during operation was(106?93±72?26)ml,(80?26±49?57)ml,(54?23±36?32)ml,respectively. The mean time of postoperative hospital stay was(7?82±1?42)d, (6?31±1?69)d,(5?97±1?51)d, respectively. There were statistically differences between the three groups on the time of renal artery clam-ping, the operative time, the blood loss and the time of postoperative hospital stay(P<0?05). The rate of transfusion during operation was 2?3%(1/44), 0(0/35), 0(0/39), respectively. The incidence of urinary leakage after operation was 0(0/44), 2?9%(1/35), 2?6%(1/39). The above clinical parameters had no significant differences among the three groups(P>0?05). All the patients were followed up for 14-60 months, and no recurrence and metastasis was found. Conclusion For small renal cell cancer, the techniques of simple enucleation and knot free suture can significantly reduce renal artery clamping time and blood loss during operation. The techniques of selective artery clamping will prolong the operation time and almost have no warm ischemia time and it can deserve further research.