CAJ | 학술논문

目的探索安全有效、简单易行的后腹腔镜下肾脏低温保护技术.方法拟行后腹腔镜下肾脏部分切除术患者22例,分为研究组和对照组.其中男12例,女10例,年龄为37～69岁,平均年龄52岁;4例为血管平滑肌脂肪瘤,18例为肾透明细胞癌.研究组在阻断患侧肾脏肾动脉后用冰盐水循环灌注系统使肾脏温度降至25℃以下后施行后腹腔镜下肾脏部分切除术;对照组同样在阻断肾动脉后施行患侧肾脏的后腹腔镜下肾脏部分切除术,但不采用肾脏低温技术.比较两组患者肾脏温度和直肠温度变化,以及两组手术前后总肾及患肾肾小球滤过率(GFR)变化.结果 22例患者手术顺利;术后无继发出血、感染及漏尿.研究组冷缺血时间(47.2±3.8) min,平均最低肾脏温度为(17.73±0.91)℃,肾脏温度达到25℃需(4.6±0.4) min;对照组热缺血时间(27.8±1.5) min,平均最低肾脏温度为(38.08±0.33)℃;研究组术前ECT示总肾GFR为(66.24±3.98) ml/min,患肾GFR为(30.57±4.07) ml/min;术后1个月总肾GFR为(53.89±7.53) ml/min,患肾GFR为(20.92±4.49) ml/min;术后3个月总肾GFR为(54.49±7.92) ml/min,患肾GFR为(21.63 ±5.21) ml/min;术后6个月总肾GFR为(54.77±7.84)ml/min,患肾GFR为(21.73±9.99) ml/min;对照组术前ECT示总肾GFR为(66.49±9.87) ml/min,息肾GFR为(30.65±5.45) ml/min;术后1个月总肾GFR为(54.89±9.61) ml/min,患肾GFR为(17.90±3.50) ml/min;术后3个月总肾GFR为(55.68±10.02) ml/min,患肾GFR为(18.09±3.39) ml/min;术后6个月总肾GFR为(55.82±5.12) mL/min,患肾GFR为(18.17±3.39) ml/min.术后随访1～16个月,未见局部复发、无转移.结论本研究采用的后腹腔镜下肾脏低温保护技术简单易行、效果确切,易于临床推广.
목적 탐색안전유효、간단역행적후복강경하신장저온보호기술.방법 의행후복강경하신장부분절제술환자22례,분위연구조화대조조.기중남12례,녀10례,년령위37～69세,평균년령52세;4례위혈관평활기지방류,18례위신투명세포암.연구조재조단환측신장신동맥후용빙염수순배관주계통사신장온도강지25℃이하후시행후복강경하신장부분절제술;대조조동양재조단신동맥후시행환측신장적후복강경하신장부분절제술,단불채용신장저온기술.비교량조환자신장온도화직장온도변화,이급량조수술전후총신급환신신소구려과솔(GFR)변화.결과 22례환자수술순리;술후무계발출혈、감염급루뇨.연구조랭결혈시간(47.2±3.8) min,평균최저신장온도위(17.73±0.91)℃,신장온도체도25℃수(4.6±0.4) min;대조조열결혈시간(27.8±1.5) min,평균최저신장온도위(38.08±0.33)℃;연구조술전ECT시총신GFR위(66.24±3.98) ml/min,환신GFR위(30.57±4.07) ml/min;술후1개월총신GFR위(53.89±7.53) ml/min,환신GFR위(20.92±4.49) ml/min;술후3개월총신GFR위(54.49±7.92) ml/min,환신GFR위(21.63 ±5.21) ml/min;술후6개월총신GFR위(54.77±7.84)ml/min,환신GFR위(21.73±9.99) ml/min;대조조술전ECT시총신GFR위(66.49±9.87) ml/min,식신GFR위(30.65±5.45) ml/min;술후1개월총신GFR위(54.89±9.61) ml/min,환신GFR위(17.90±3.50) ml/min;술후3개월총신GFR위(55.68±10.02) ml/min,환신GFR위(18.09±3.39) ml/min;술후6개월총신GFR위(55.82±5.12) mL/min,환신GFR위(18.17±3.39) ml/min.술후수방1～16개월,미견국부복발、무전이.결론 본연구채용적후복강경하신장저온보호기술간단역행、효과학절,역우림상추엄.
Objective To establish a new retroperitoneal laparoscopic technique which can keep the kidney in cold ischemia and has the characteristics of safety,effective and simplicity.Methods Twenty-two patients who needs to do the retroperitoneal laparoscopic partial nephrectomy were divided into two groups:the research group and the control group.There were 12 males and 10 females with average age of 37-69 years old.There were 4 cases of angiomyolipoma,and 18 cases of renal cell carcinoma.In research group,the renal temperature was reduced by circumfusion system of ice saline after clamping the renal artery,and then the retroperitoneal laparoscopic partial nephrectomy was done.In the control group,we did the same as well except the renal hypothermia.The renal temperature and the rectal temperature during the surgery,and the glomerular filtration rate (GFR) of both bilateral kidneys and the affected kidney before and after the surgery were compared.Results All the surgical operations were done successfully in both groups.No post-operative bleeding,inflammation and leakage of urine occurred.In the research group,the average cold ischemia time was (47.2 ±3.8) min,the average minimum renal temperature was (17.73 ± 0.91),and the average time reducing the renal temperature to 25 ℃ was (4.6 ±0.4) min.In the control group,the average cold ischemia time was (27.8 ± 1.5) min,and the average minimum renal temperature was (38.08 ± 0.33)℃.In the research group,the average GFR of the bilateral kidneys and the affected kidneys was (66.24 ±3.98) and (30.57 ±4.07) ml/min one week before the surgery,that was 53.89 ±7.53 and (20.92 ±4.49) ml/min one month after the surgery,that was (54.49 ±7.92) and (21.63 ±5.21) ml/min 3 months after the surgery,and that was (54.77 ± 7.84) and (21.73 ± 9.99) ml/min 6 months after the surgery,respectively.In the control group,the average GFR of th bilateral kidneys and the affected kidney was 66.49 ±9.87 and (30.65 ±5.45) ml/min one week before the surgery,that was (54.89 ±9.61) and (17.90 ±3.50) ml/min one month after surgery,that was (55.68 ± 10.02) and (18.09 ±3.39) ml/min 3 months after the surgery,and that was 55.82 ±5.12 and (18.17 ±3.39) ml/min 6 months after the surgery,respectively.The follow-up duration was 1-16 months without local recurrence and metastasis.Conclusion The new equipment with circumfusion system of ice saline can keep the kidney in cold ischemia,and is easy-to-use and efficient,especially it doesn' t need special equipment so it can be widely used in retroperitoneal laparoscopic surgery.