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目的探讨腹腔镜保留肾单位术(LPN)对术后肾功能的影响。方法 37例肾癌患者分为两组:LPN组16例;开放性保留肾单位术(OPN)组21例,实施开放性保留肾单位术。检测术前、术后1个月和6个月的肌酐清除率。麻醉时间、动脉阻断时间、术中血压及术中红细胞压积的变化,分别作为评估术后肾功能变化的影响因素,分析影响两组术后肾功能的预测因素。结果两组患者的年龄、性别、基础疾病、术前肾功能及肿瘤大小等因素未见明显差异。术后红细胞压积的下降与术后1个月及6个月肾功能的下降有关联。OPN组的麻醉时间较LPN组略短;LPN组术中出血量明显较OPN组少。结论 LPN可以成为治疗小肾癌的首选手术方式。
Objective To investigate the effect of laparoscopic nephron (LPN) on postoperative renal function. Methods Thirty-seven patients with renal cell carcinoma were divided into two groups: LPN group (n = 16), open preserving nephron (OPN) group (n = 21) and open nephron preservation. Preoperative, postoperative 1 month and 6 months of creatinine clearance. The time of anesthesia, the time of artery occlusion, intraoperative blood pressure and intraoperative hematocrit changes were used as the influencing factors to evaluate the changes of postoperative renal function. The predictive factors influencing the postoperative renal function were analyzed. Results There were no significant differences in age, gender, underlying disease, preoperative renal function and tumor size between the two groups. Postoperative hematocrit decline and postoperative 1 month and 6 months decreased renal function associated. The anesthesia time in OPN group was slightly shorter than that in LPN group. The bleeding volume in LPN group was significantly lower than that in OPN group. Conclusion LPN can be the first choice for the treatment of small renal cell carcinoma.