摘要
目的:分析早期开放血流技术在肾门部中央型肾肿瘤保肾手术中的临床疗效。方法:为18例肾门部中央型肾肿瘤患者行腹腔镜肾部分切除术,肿瘤最大径(2.8±1.1)cm,R.E.N.A.L评分(8.5±1.2)分。术前行智能型定性定量分析三维重建明确肾动脉分支情况及与肿瘤的关系。结果:16例患者顺利完成腹腔镜肾部分切除术,2例中转开放手术。手术时间平均(134.5±18.4)min,平均热缺血时间(19.1±3.8)min,术中出血量平均(88.5±10.2)mL。16例患者中3例术后发生严重出血,2例经血管造影及选择性肾动脉栓塞治疗后痊愈,1例保守治疗无效行开放肾切除术;1例患者术后出现漏尿,经保守治疗后痊愈。术后随访患肾肾小球滤过率,绝大部分患者术后患肾肾小球滤过率下降幅度不明显,提示患肾功能恢复良好。结论:早期开放血流技术的核心理念是“2+1”缝合技术,其技术准备是智能型定性定量分析三维血管重建,其技术革新是序贯血流阻断技术。对于肾门部中央型肾肿瘤而言,包含一系列技术保障的早期血流开放技术对患肾功能的远期恢复具有重要意义,值得临床应用。
Objective:To summarize the curative effect of early open blood flow technique for hilar central renal tumors in laparoscopic partial nephrectomy(LPN).Methods:A total of 18 patients underwent LPN for hilar central renal tumors.The maximum diameter was(2.8±1.1)mm,the R.E.N.A.L score was(8.5±1.2).Preoperative intelligent qualitative and quantitative analysis three-dimensional reconstruction was performed to identify the renal artery branches and their relationship with the tumors.Renal artery,renal vein and ureter were separated.Renal tumors were completely exposed,and their relationship with the branches of renal artery and renal vein and the adjacent ureter was clarified.Intracavity ultrasound was used to accurately determine the tumor boundary.Results:Sixteen patients successfully underwent LPN,and 2 patients were converted to open partial nephrectomy.The mean operative time was(134.5±18.4)min,the mean warm ischemia time was(19.1±3.8)min,and the mean intraoperative blood loss was(88.5±10.2)mL.Among the 16 patients,3 suffered from severe bleeding complications,2 were cured by angiography and selective renal artery embolization,1 patient underwent open nephrectomy because of ineffective conservative treatment.One patient suffered from leakage of urine after operation,which was cured by conservative treatment.After follow-up,most of the patients had no significant decrease in glomerular filtration rate,suggesting a good recovery of renal function.Conclusions:The core idea of early open blood flow technology is"2+1"suture technique.Its technical preparation is intelligent qualitative and quantitative analysis three-dimensional vascular reconstruction,and its technical innovation is sequential blood flow blocking technique.For hilar central renal tumors,early open blood flow technique with a series of technical guarantees is of great benefit to the long-term recovery of renal function,and has better clinical application value.
作者
施展
曲发军
胡传义
褚健
叶剑青
干思舜
储传敏
曹建伟
章璟
郑景存
徐冀东
张向民
张鹤
崔心刚
SHI Zhan;QU Fa-jun;HU Chuan-yi(Department of Urology,Taizhou First People s Hospital,Taizhou 318020,China;The Shanghai Gongli Hospital Affiliated to Second Military Medical University)
出处
《腹腔镜外科杂志》
2019年第11期859-862,共4页
Journal of Laparoscopic Surgery
基金
上海市科委医学引导类(中、西医)科技支撑项目(17411960200)
上海市科学技术委员会优秀学术带头人计划(19XD1405100)
上海市“医苑新星”青年医学人才培养资助计划-杰出青年医学人才类
上海浦东新区临床高峰学科(PWYgf2018-03)
上海市浦东新区公利医院拔尖人才(GLRb2019-01)
孟超人才培养计划-领军人才后备培养对象
