Objective To observe the effect of laparoscopic partial nephrectomy without blocking renal artery for patients with T1a stage of renal cell carcinoma.Methods 11 patients with T1a stage of renal cell carcinoma underwent laparoscopic partial nephrectomy without blocking renal artery in Cangzhou Central Hospital Affiliated to Hebei Medical University (“our hospital” for short) from June 2012 to January 2015 were selected as the observation group.While 16 patients with T1a stage of renal cell carcinoma underwent laparoscopic partial nephrectomy with blocking renal artery in our hospital from January 2008 to May 2012 were selected as the control group.Indications of operation,detection index and prognosis were compared between two groups.SPSS 21.0 software was used for statistical analysis.Results Duration of operation,intraoperative blood loss,postoperative exhaust time,postoperative defecation time,postoperative hospitalization time between the two groups had no significant differences (P ＞ 0.05).In the observation group,preoperative levels of Scr,BUN,GFR were (101.12±21.54) μmol/L (3.60±0.19) μmol/L,(42.24±5.26) mL/min respectively;postoperative levels of Scr,BUN,GFR were (98.96±26.36) μmol/L,(3.64±0.23) μmol/L,(41.57±4.92) mL/min respectively.There were no statistically significant differences in these indications between before and after operation in the observation group (P ＞ 0.05).In the control group,preoperative levels of Scr,BUN,GFR were (99.73±17.02) μmol/L,(3.62±0.28) μmol/L,(41.84±6.01) mlmin respectively,postoperative levels of Scr,BUN,GFR were (110.85±16.01) μmol/L,(4.85±0.39) μmol/L,(32.20±4.62) mL/min respectively.After operation the levels of Scr and BUN significantly higher than those of before operation,and GFR level was significantly lower than that of before operation,with statistically significant differences (P ＜ 0.05).Comparison between the two groups,before operation the levels of Scr,BUN,GFR had no statistically significant differences between the two groups (P ＞ 0.05);after operation the levels of Scr,BUN in the observation group were significantly lower than those of the contorl group,and GFR level was significantly higher than that of the contorl group,with statistically significant differences (P ＜ 0.05).The intraoperative blood transfusion rate was 9.90％ in the observation group,while 6.25％ in the control group,there was no significant difference between the two groups (P ＞ 0.05).There was no postoperative complication in the observation group,while there was 1 case of urethral injury in the control group after operation,without statistically significant difference between the two groups (P ＞ 0.05).After 1 year of follow-up,there was no recurrence in the two groups.Conclusion The effect of laparoscopic partial nephrectomy without hlockiug renal artery in patients with T1a stage of renal cell carcinoma is similar with traditional operation,which can avoid renal warm ischemia,improve the renal microcirculation perfusion and glomerular filtration function.It is worthy of popularization and application.%目的 观察腹腔镜下对T1a期肾癌患者行非阻断肾动脉肾部分切除术的效果.方法 选取2012年6月～2015年1月河北医科大学附属沧州市中心医院(以下简称“我院”)收治的行非阻断肾动脉肾部分切除术的11例T1a期肾癌患者作为观察组,同时选取2008年1月～2012年5月我院行传统阻断肾动脉的后腹腔镜肾部分切除术的16例T1a期肾癌患者作为对照组.比较两组手术指征、检测指标、预后情况.采取SPSS 21.0软件行统计学分析.结果 两组患者的手术时间、术中出血量、术后排气时间、术后排便时间、术后住院时间比较,差异无统计学意义(P＞0.05).观察组术前血清肌酐(Scr)、尿素氮(BUN)、患肾肾小球滤过率(GFR)水平分别为(101.12±21.54)μmol/L、(3.60±0.19)μmol/L、(42.24±5.26)mL/min,术后分别为(98.96±26.36) μmol/L、(3.64±0.23)μmol/L、(41.57±4.92)mL/min,术前术后比较差异均无统计学意义(均P＞0.05);对照组术前Scr、BUN、GFR水平分别为(99.73±17.02)μmol/L、(3.62±0.28) μmol/L、(41.84±6.01)mL/min,术后分别为(110.85±16.01) μmol/L、(4.85±0.39) μmol/L、(32.20±4.62)mL/min,术后Scr、BUN水平较术前显著升高,而GFR水平较术前显著下降,差异有统计学意义(P＜0.05);两组间比较,术前各指标差异无统计学意义(P＞0.05);术后观察组Scr、BUN水平低于对照组,GFR水平高于对照组,差异有统计学意义(P＜0.05).观察组术中输血率为9.09％,对照组为6.25％,两组比较差异无统计学意义(P＞0.05).观察组术后无并发症,对照组术后发生1例输尿管损伤,两组并发症发生率比较差异无统计学意义(P＞0.05).经1年随访,两组患者均无一例复发.结论 腹腔镜下对T1a期肾癌患者行非阻断肾动脉肾部分切除术可取得与传统手术相似的效果,且能避免肾脏热缺血,改善肾脏微循环灌注与肾小球滤过功能,值得推广应用.
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