后腹腔镜下肾动脉全阻断肾部分切除对肾功能影响的综合评估

摘要

目的：：报告泌尿外科4年内后腹腔镜下肾肿瘤剜除的97例患者肾动脉阻断时间与术后肾功能受损情况。方法：回顾分析2011年7月~2015年3月后腹腔镜肾肿瘤剜除患者97例,肾动脉全阻断在17~25 min组(A组)36例,男20例,女16例,年龄(52.3±7.8)岁,肿瘤直径(2.9±0.5)cm；肾动脉全阻断在26~30 min组(B组)42例,男23例,女19例,年龄(51.3±8.9)岁,肿瘤直径(2.8±0.6)cm；肾动脉全阻断在31~45 min组(C组)19例,男10例,女 9例,年龄(53.4±7.2)岁,肿瘤直径(3.0±0.7) cm。结果：改良 R.E.N.A.L.评分 A组(8.6±0.6)分；B组(8.2±0.5)分；C组(9.2±0.6)分,R.E.N.A.L.评分组间比较差异有统计学意义,进行组间两两比较时,A组和B组之间比较差异无统计学意义,C 组和 A 组、B组之间均差异有统计学意义；A组术前GFR(43.2±6.2)ml/min,术后3个月GFR (36.7±5.0)ml/min,B组术前 GRF(45.3±4.7)ml/min,术后 3个月 GRF (38.3±4.7)ml/min；C组术前 GRF(44.6±4.8)ml/min,术后 3个月 GFR (31.5±5.6)ml/min。术前各组之间差异无统计学意义,术后 A 组和 B 组之间比较差异无统计学意义,C 组和 A 组、B组之间差异有统计学意义(P值分别为：0.000和0.000)。结论：术前改良 R.E.N.A.L.评分与后腹腔镜下肾动脉阻断时间相关,热缺血时间控制在30 min内的肾动脉全阻断肾肿瘤剜除术后肾功能损伤较小。%Objective:To evaluate the correlation between the time of renal artery clamping and the kidney function injury of 97 patients received retroperitoneal laparoscopic partial nephrectomy in our hospital within 4 years.Methods:Ninety-seven patients with renal carcinoma,who underwent retroperitoneal laparoscopic partial nephrec-tomy from July 2011 to March 2015,were divided into three groups.The group A contained 36 cases,the time of renal artery clamping were 17-25 min,the Male/Female ratio was 20/16,the mean age was (52.3±7.8)years old and the average tumor diameter was (2.9±0.5)cm;the group B contained 42 cases,the time of renal artery clamping were 26-30 min,the Male/Female ratio was 23/20,the mean age was (51.3±8.9)years old and the average tumor diameter was (2.8±0.6)cm;the group A contained 19 cases,the time of renal artery clamping were 30-45 min,the Male/Female ra-tio was 1 0/9 ,the mean age was (5 3.4 ± 7.2 )years old and the average tumor diameter was (3.0 ± 0.7 )cm.Results:The R.E.N.A.L.score in group A was (8.6±0.6);while it was (8.2±0.5)in group B,in group C,it was (9.2± 0.6),When pairwise comparisons were made between each groups,the difference between group A and group B was no significant but was significant between group C and other two groups.The GRF before and 3 months after operation were compared.The difference between three groups was no significant before the operation (group A:43.2±6.2 mL/min, group B:45.3±4.7 mL/min,group C:44.6±4.8 mL/min).There was also no significant difference between group A and group B after operation for 3 months (group A:36.7±5.0 mL/min,group B:38.3±4.7 mL/min,and yet group C (GRF:31.5±5.6 mL/min)had significant differences as compared with that of group A and group B after 3 month of operation.Conclusions:The time of renal artery occlusion was related to the R.E.N.A.L.score in retroperitoneal laparo-scopic partial nephrectomy.Renal artery occlusion time should be controlled within 30 min.