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目的探讨“蛙跳式”选择性肾动脉阻断法在腹腔镜保留肾单位手术中的临床应用。方法 2014年8月至2015年8月,对5对尸体肾脏和20个行肾切除术的肾脏进行肾动脉血管解剖,观察动脉的分支走行及其与肾门的位置关系,研究选择性肾动脉阻断法的解剖学基础。回顾性分析10例腹腔镜保留肾单位手术,其中5例采用“蛙跳式”选择性分支动脉阻断法,另外5例随机选取同期行传统选择性分支动脉阻断法的病例,分别记录游离肾脏肿瘤后至阻断分支动脉的时间和热缺血时间,初步研究“蛙跳式”选择性分支动脉阻断法的临床应用效果。结果 5对尸体肾脏和20个肾切除术后的肾脏中分别有72.2%(39/54)和70.8%(68/96)的分支动脉沿着肾门“门框”处进入肾脏。临床应用方面,10例腹腔镜保留肾单位手术均安全顺利完成。5例行“蛙跳式”肾动脉阻断的患者中有1例因分支动脉阻断效果不理想,更改为阻断肾动脉主干。传统和“蛙跳式”选择性分支动脉阻断法游离肾脏肿瘤后至阻断分支动脉的时间分别为10~18min和6~11min,热缺血时间分别为15~25min和14~26min。结论 “蛙跳式”选择性分支动脉阻断法不仅可减少肾功能的损伤,且操作更简单、具有可重复性,危险性更低,对术者的操作技术要求较传统分支动脉阻断法的要求更低,更利于推广。
Objective To investigate the clinical application of “leapfrog” selective renal artery occlusion in laparoscopic nephron-preserving surgery. Methods From August 2014 to August 2015, renal arteries of 5 pairs of cadaver kidneys and 20 nephrectomized kidneys were dissected. The arterial branches were observed and their relationship with the position of the renal hilus was observed. The effects of selective renal artery Anatomy of the occlusion method. Ten patients undergoing laparoscopic nephron surgery were retrospectively analyzed. Among them, 5 were treated with “leapfrog” selective branch artery occlusion and 5 were randomly selected with traditional selective branch artery occlusion To record the time from the free kidney tumor to block the branch artery and the time of warm ischemia, to study the clinical effect of the “leapfrog” selective branch artery occlusion method. RESULTS: Of 52 renal cadaveric and 20 nephrectomized kidneys, 72.2% (39/54) and 70.8% (68/96) of the branch arteries entered the kidney along the renal door / doorframe respectively. Clinical application, 10 cases of laparoscopic nephron surgery were safely and successfully completed. One of 5 patients with “leapfrog” renal artery occlusion had an unsatisfactory blocking effect on the branch artery and changed to block the renal artery. Traditional and “leapfrog” selective branch artery occlusion free kidney tumor to block the branch artery time were 10 ~ 18min and 6 ~ 11min, warm ischemia were 15 ~ 25min and 14 ~ 26min . Conclusion “Frog jumping” selective branch artery occlusion not only can reduce the damage of renal function, and the operation is more simple and reproducible, the risk is lower, the technical requirements of the operation of the surgeon than the traditional branch artery resistance Broken law requires lower, more conducive to the promotion.