中国医科大学学报

中国医科大学学报
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中国医科大学学报 ›› 2018, Vol. 47 ›› Issue (6): 562-565.doi: 10.12007/j.issn.0258‐4646.2018.06.018

• 论著 • 上一篇    下一篇

非阻断技术在腹腔镜免缝合肾部分切除术中的应用

刘碧天, 吴斌   

  1. 中国医科大学附属盛京医院泌尿外科, 沈阳 110004
  • 收稿日期:2017-08-17 出版日期:2018-06-30 发布日期:2018-05-29
  • 通讯作者: 吴斌 E-mail:wubin8888@aliyun.com
  • 作者简介:刘碧天(1988-),男,医师,硕士.

Off-clamp Technique for Laparoscopic Sutureless Partial Nephrectomy

LIU Bitian, WU Bin   

  1. Department of Urology, Shengjing Hospital, China Medical University, Shenyang 110004, China
  • Received:2017-08-17 Online:2018-06-30 Published:2018-05-29

摘要: 目的 探讨术中非阻断肾蒂在腹腔镜免缝合肾部分切除术中的安全性及有效性。方法 总结分析2016年2月至2017年4月中国医科大学附属盛京医院泌尿外科收治并由同一术者连续完成的88个病例,术前均怀疑单侧肾脏恶性肿瘤(非孤立肾),筛选出肿瘤直径>2 cm的病例58例,其中非阻断组26例,阻断组32例。2组患者的年龄、男/女比例、肿瘤左/右侧比例、肿瘤最大径、术前肾小球滤过率估计值(eGFR)和RENAL评分等比较,差异均无统计学意义。结果 非阻断组与阻断组术中出血量(193.1 mLvs 190.0 mL,P=0.957)无统计学差异,手术时间(131.3 min vs 181.2 min,P<0.001)、术后短期eGFR降低[0.4 mL/(min·1.73 m2) vs 8.0 mL/(min·1.73 m2),P=0.034],3~6个月eGFR降低[2.1 mL/(min·1.73 m2) vs 7.8 mL/(min·1.73 m2),P=0.154]和术后住院时间(10.5 d vs 14.9 d,P=0.005),有统计学差异。结论 非阻断肾蒂在腹腔镜下免缝合肾部分切除术中是安全、有效的。非阻断肾蒂没有增加术中出血量,对于术后短期肾功能的损伤较小,可以明显缩短手术时间与术后住院时间。

关键词: 肾部分切除术, 腹腔镜, 非阻断, 免缝合

Abstract: Objective To evaluate the safety and efficacy of off-clamp in sutureless laparoscopic partial nephrectomy. Methods From February 2016 to April 2017, 88 cases were analyzed. According to the results, before surgery, all the cases were suspected as unilateral kidney cancer(non-isolated kidney). The screening identified 58 cases of tumor with a diameter of >2 cm, including 26 cases in the off-clamp group and 32 in the clamp group. No significant differences were found between the off-clamp and clamp groups in terms of patient age and sex, tumor location and size, preoperative estimated glomerular filtration rate(eGFR), and RENAL score. Results No significant difference in intraoperative blood loss was observed between the off-clamp and clamp groups(193.1 mL vs 190.0 mL, P=0.957). However, the operation time(131.3 min vs 181.2 min, P<0.001) and postoperative hospital stay(10.5 d vs 14.9 d, P=0.005) were shorter in the off-clamp group. Short-term(1 week after operation) eGFR reduction showed significant differences between the groups[0.4 mL/(min·1.73 m2) vs 8.0 mL/(min·1.73 m2), respectively;P=0.034]. At 3-6 months after operation, the decrease in eGFR also showed no significant difference between the groups[2.1 mL/(min·1.73 m2) vs 7.8 mL/(min·1.73 m2), P=0.034]. Conclusion Off-clamp is safe and effective in sutureless laparoscopic partial nephrectomy. In this study, off-clamp renal pedicle did not increase the amount of intraoperative blood loss, reduced short-term damage to renal function, and significantly shortened the operation time and postoperative hospital stay. However, a large sample study and long-term follow-up observation are still needed to clarify its long-term efficacy.

Key words: partial nephrectomy, laparoscopic, off-clamp, sutureless

中图分类号: 

  • R737.11
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