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目的:比较肾动脉阻断与不阻断下行腹腔镜肾部分切除术对于治疗低R.E.N.A.L评分肾肿瘤的有效性和安全性。方法:回顾性分析2013年6月~2014年3月我院同一名医师完成的腹腔镜肾部分切除术73例临床资料,R.E.N.A.L评分均≤6,其中肾动脉阻断组54例,肾动脉无阻断组19例。比较两组患者一般资料、围手术期及手术前后肾功能变化等指标。结果:手术均顺利完成,无中转开放。阻断组术中肾动脉阻断时间为(18.5±8.5)min。阻断组较无阻断组手术时间长(130.1±20.5vs.104.2±13.6min)、术中失血少(153.3±56.6vs.223.4±92.7ml),差异均有统计学意义(P<0.05)。两组间输血率、切缘阳性率、术后并发症发生率及术后住院时间差异无统计学意义(P>0.05)。两组间术后1周血肌酐变化值的差异无统计学意义(15.3±4.1vs.14.3±4.2μmol·L-1,P>0.05),术后1个月阻断组患肾GFR较后者差(40.1±5.6vs.44.2±7.2ml·min-1),差异有统计学意义(P<0.05),两组间术后1年患肾GFR的差异无统计学意义(46.5±5.7vs.47.0±7.1ml·min-1,P>0.05)。术后随访16个月,无复发病例。结论:对于R.E.N.A.L评分≤6分肾肿瘤行腹腔镜肾部分切除术,阻断肾动脉可减少术中出血且不增加切缘阳性率。阻断和无阻断肾动脉对短期肾功能的影响有差别,而对长期肾功能的影响无差别。
OBJECTIVE: To compare the efficacy and safety of renal artery partial or partial laparoscopic partial nephrectomy for the treatment of renal tumors with low R.E.N.A.L score. Methods: The clinical data of 73 cases of laparoscopic partial nephrectomy performed by the same physician in our hospital from June 2013 to March 2014 were retrospectively analyzed. The RENAL scores were all ≤6, including 54 cases of renal artery occlusion group, Blocking group of 19 cases. The general data of two groups were compared, and the perioperative and preoperative and postoperative renal function indexes were compared. Results: The operation was successfully completed, no transit open. Interventional renal artery occlusion time was (18.5 ± 8.5) min. The occlusion group had longer operation time (130.1 ± 20.5 vs. 104.2 ± 13.6 min) and less blood loss (153.3 ± 56.6 vs 223.4 ± 92.7 ml) than those without occlusion group (P <0.05) . Blood transfusion rate, positive margins, postoperative complications and postoperative hospital stay were not significantly different between the two groups (P> 0.05). There was no significant difference in serum creatinine between the two groups at 1 week after operation (15.3 ± 4.1 vs.14.3 ± 4.2 μmol·L-1, P> 0.05) (40.1 ± 5.6 vs.44.2 ± 7.2ml · min-1), the difference was statistically significant (P <0.05). There was no significant difference in GFR between the two groups (46.5 ± 5.7 vs .47.0 ± 7.1 ml · min-1, P> 0.05). All cases were followed up for 16 months without recurrence. Conclusion: Laparoscopic partial nephrectomy for renal tumors with R.E.N.A.L score of ≤6 points can block the renal artery and reduce intraoperative bleeding without increasing the positive rate of the margins. The effects of blocking and unobstructed renal arteries on short-term renal function differed but had no effect on long-term renal function.