郝彤彤 孙建涛 杨金辉 康延杰

【摘要】 目的：分析非阻断肾动脉腹腔镜肾部分切除术治疗T1a期肾癌的可行性。方法：回顾性分析2012年2月-2014年5月本院收治的68例T1a期肾癌患者的临床资料，试验组37例实施腹腔镜下非阻断肾动脉肾部分切除术，对照组31例实施腹腔镜下选择性阻断肾动脉肾部分切除术，比较两种术式的手术时间、术中出血量、术中及术后并发症、术后肾功能恢复情况。结果：68例均手术顺利完成，无一例中转开放。两组患者均未输血，试验组与对照组术中出血量分别为（127.6±18.3）、（85.8±9.1）mL，两组比较差异有统计学意义（P<0.05）；试验组与对照组手术时间分别为（96.2±12.3）、（91.4±10.1）min，住院时间分别为（8.0±2.1）、（7.5±2.3）d，差异均无统计学意义（P>0.05）；术后病理报告切缘均为阴性，术中术后无明显并发症。试验组和对照组术后3个月患肾GFR为（36.2±12.4）、（25.9±14.3）mL/min（P<0.05）。术后随访12～39个月，患侧肾功能均正常，无肿瘤复发及转移。结论：非阻断肾动脉腹腔镜肾部分切除术治疗T1a期肾癌安全、有效，可最大限度的减少肾热缺血时间，保护患肾功能。

【关键词】 腹腔镜肾部分切除术； 肾癌T1a期； 非阻断肾动脉

Clinical Analysis of Laparoscopic Partial Nephrectomy for T1a Renal Cell Carcinoma without Clamping Renal Artery/HAO Tong-tong，SUN Jian-tao，YANG Jin-hui，et al.//Medical Innovation of China，2016，13（06）：022-025

【Abstract】 Objective： To analyse the feasibility of laparoscopic partial nephrectomy for renal cell carcinoma of T1a stage without clamping of renal artery. Method：The clinical data of 68 patients with T1a renal cell carcinoma who were treated from February 2012 to May 2014 were retrospectively studied.All patients were divided to two groups：the patients of test group （n=37） recieved LPN without clamping of renal artery， and the the patients of control group recieved LPN with clamping of renal artery. Operation time， intraoperative blood loss， intraoperative and postoperative complications， and postoperative recovery of renal function were compared. Result：All the 68 cases were operated successfully， without a case of blood transfusion or transfer to open. The mean blood loss were （127.6±18.3） and （85.8±9.1） mL of the test group and the control group（P<0.05）.The operation time were （96.2±12.3） and （91.4±10.1） min ， the hospital stay were （8.0±2.1） and （7.5±2.3） d of the test group and the control group，there were no statistically significant differences （P>0.05）. The GFR were （36.2±12.4） and （25.9±14.3）mL/min of the test group and the control group after 3 months of operation， there was statistically significant difference（P<0.05）. There were no complications during and after surgery.Postoperative pathology showed the incisal margin were negative.All patients had normal renal function and had no tumor recurrence or metastasis followed up for 12-39 months. Conclusion：Laparoscopic partial nephrectomy without clamping of renal artery is safe and effective and can reduce the time of renal warm ischemia and protect the renal function.

【Key words】 Laparoscopic partial nephrectomy； T1a renal cell carcinoma； Non clamping renal artery

First-authors address：Luoyang Central Hospital Affiliated of Zhengzhou University，Luoyang 471000，China

doi：10.3969/j.issn.1674-4985.2016.06.007

随着影响学技术的发展，无症状小肾癌的检测率明显增加。肾部分切除可达到与根治性切除同样治疗肿瘤的效果，并能尽量保存肾功能，提高生活质量。腹腔镜下肾部分切除术（laparoscopic partial nephrectomy，LPN）已经成为T1a期肾癌的标准术式。在LPN中，为控制术中出血以及保持视野清晰，往往需要短暂阻断肾蒂血管，而阻断肾血管可引起肾脏缺血及再灌注损伤。为了最大限度保护患侧肾功能，本院在2012年2月-2014年5月进行了非阻断与选择性阻断肾动脉LPN的对比研究，分析其安全性及治疗效果。

1 资料与方法

1.1 一般资料 本研究共68例，根据2009年AJCC肾癌TNM分期，均为T1aN0M0期。所有患者术前均行CT血管成像，并行肾动脉三维重建，充分评估肾动脉与肿瘤的解剖学关系，明确供应肿瘤的肾段动脉。……