CAJ | 학술논문

目的：比较全阻断、选择性肾段动脉阻断行腹腔镜肾部分切除术的手术效果和安全性。方法选择2010年6月～2013年5月腹腔镜下肾部分切除术的患者56例，根据肾动脉阻断方式分为选择性阻断组18例和全阻断组38例。比较两组患者肾动脉阻断时间、术中出血量、术后肌酐、住院天数和术后短期并发症发生情况。结果两组手术均获成功。切缘病理检查均为阴性。选择性阻断组阻断时间（33．94±9．40） min、术中出血量（155．56±70．50）mL、术前肌酐（68．39±15．70）μmol/L、术后肌酐（96．39±26．40）μmol/L、术后肌酐降低百分比41％±24％、住院天数（9．17±2．70）d、术中输血1例（5．6％）、术后并发症1例（尿瘘）；全阻断组分别为阻断时间（23．13±10．80）min、术中出血量（143．68±104．40）mL、术前肌酐（70．02±20．00）μmol/L、术后肌酐（105．70±38．30）μmol/L、术后肌酐降低百分比58％±34％、住院天数（11．37±3．20） d、术中输血2例（5．3％）、术后并发症2例（多器官功能不全1例、肾积水1例）。两组患者术中肾动脉阻断时间、术中出血量、住院时间、术前肌酐、术中输血率、并发症发生率比较P均＞0．05，术后肌酐及术后肌酐降低百分比较P均＜0．05。结论对于较小肾癌，选择性肾动脉阻断术手术时间延长，但肾脏组织热缺血区域小，出血无明显增加，利于保护正常区域肾单位，术后肾功能恢复更好。
목적：비교전조단、선택성신단동맥조단행복강경신부분절제술적수술효과화안전성。방법선택2010년6월～2013년5월복강경하신부분절제술적환자56례，근거신동맥조단방식분위선택성조단조18례화전조단조38례。비교량조환자신동맥조단시간、술중출혈량、술후기항、주원천수화술후단기병발증발생정황。결과량조수술균획성공。절연병리검사균위음성。선택성조단조조단시간（33．94±9．40） min、술중출혈량（155．56±70．50）mL、술전기항（68．39±15．70）μmol/L、술후기항（96．39±26．40）μmol/L、술후기항강저백분비41％±24％、주원천수（9．17±2．70）d、술중수혈1례（5．6％）、술후병발증1례（뇨루）；전조단조분별위조단시간（23．13±10．80）min、술중출혈량（143．68±104．40）mL、술전기항（70．02±20．00）μmol/L、술후기항（105．70±38．30）μmol/L、술후기항강저백분비58％±34％、주원천수（11．37±3．20） d、술중수혈2례（5．3％）、술후병발증2례（다기관공능불전1례、신적수1례）。량조환자술중신동맥조단시간、술중출혈량、주원시간、술전기항、술중수혈솔、병발증발생솔비교P균＞0．05，술후기항급술후기항강저백분비교P균＜0．05。결론대우교소신암，선택성신동맥조단술수술시간연장，단신장조직열결혈구역소，출혈무명현증가，리우보호정상구역신단위，술후신공능회복경호。
Objective To compare the efficacy and safety on renal carcinoma with Segmental Artery Clamping and main renal artery clamping retroperitoneal laparoscopic partial nephrectomy( RLPN).Methods A retrospective analysis of a consecutive series of 56 patients who underwent RLPN ( Including Segmental Artery Clamping and main renal artery clamping) from June 2010 to May 2013.According to the renal artery occlusion methods ,56 patients divided into 38 pa-tients underwent surgeries with main renal artery clamping, and 18 underwent surgeries with segmental artery clamping. Chief complaint Blood loss, warm ischemia (WI) time,the creatinine after operation, Length of stay, and short term com-plications after operation.Result All the patients'surgical were successful and the margins were negative the selective blockade group,WI(33.94 ±9.40)min,blood loss was (155.56 ±70.50)mL,the Creatinine before and afer surgery were (68.39 ±15.70)μmol/L and(96.39 ±26.40)μmol/L respectively.Postoperative creatinine percentage was 41%±24%, Length of stay was(9.17 ±2.70)d, 1 case intraoperative blood transfusion (5.6%), 1 cases of postoperative complica-tions (fistula).full occlusion group were (23.13 ±10.80) min、 (143.68 ±104.40) mL、(70.02 ±20.00)μmol/L、(105.70 ±38.30)μmol/L、58%±34%、(11.37 ±3.20)d respectively.2 case intraoperative blood transfusion (5.3%), 2 cases of postoperative complications (1 cases of Multiple organ dysfunction and 1 case of hydronephrosis ).Patients in the two group of renal artery occlusion time, amount of bleeding, hospitalization time, preoperative creatinine, intraopera-tive blood transfusion rate, complication rate compared to P>0.05, postoperative creatinine and postoperative creatinine decreased percentage of P<0.05.Conclusion For small renal cell carcinoma, selective renal artery occlusion operation time is prolonged, but kidney warm ischemia area is small, no hemorrhage increased significantly, to protect the normal re-gional renal units, better recovery of renal function after operation.Conclusions:LPN with segmental artery clamping is safe and feasible in clinical practice.It minimizes the intraoperative WI injury and improves early postoperative affected renal function compared with main renal artery clamping.