摘要
目的探索肾动脉低温灌注+机器人辅助腹腔镜肾部分切除术治疗复杂肾肿瘤的安全性和有效性。方法回顾性分析2020年3月至2021年12月浙江省人民医院收治的11例复杂性肾肿瘤患者的临床资料。男7例,女4例;年龄(64.64±13.56)岁,体质量指数(23.93±3.87)kg/m^(2)。中位R.E.N.A.L.评分中位值8(7,9)分,患肾肾小球滤过率(64.40±25.52)ml/min。所有患者均行肾动脉低温灌注,利用导管将4℃乳酸钠林格液注入患肾,在术中使其维持低温状态,后行机器人辅助腹腔镜肾部分切除术。记录术中数据及术后并发症。术后随访患者肾功能、泌尿系CT检查等。结果11例均顺利完成手术。术中肾动脉阻断时间为(34.09±2.84)min,患者术中体温为(36.10±0.44)℃,手术时间为(126.73±47.08)min,术中出血量为(81.82±53.07)ml。无尿漏、低体温、发热等治疗相关不良反应。术后3个月患肾肾小球滤过率(59.06±25.67)ml/min,与术前比较差异无统计学意义(P=0.636)。结论肾动脉低温灌注+机器人辅助腹腔镜肾部分切除术治疗复杂性肾肿瘤,可使患者耐受更长的热缺血时间,较好地保留肾功能,并发症少,是一种可选择的手术方式。
Objective To explore the safety and efficacy of renal arterial hypothermia perfusion in robot-assisted laparoscopic partial nephrectomy.Methods The data of 11 patients with complex renal tumors admitted to our hospital from March 2020 to December 2021 were retrospectively analyzed.There were 7 males and 4 females.The patients’age was(64.64±13.56)years old.The median R.E.N.A.L.score was 8(7,9)points.Preoperative glomerular filtration rate(GFR)was(64.40±25.52)ml/min.All patients had a renal artery cold solution perfusion robot-assisted laparoscopic partial nephrectomy.4℃sodium lactate Ringer's solution was injected into the affected kidney by the catheter,which could provide the kidney a hypothermic state during the operation and protected the renal function during the long period of warm ischemia.The intraoperative data and postoperative complications were recorded.The data of postoperative renal function,routine urine test,urinary CT,preoperative and postoperative glomerular filtration rate(GFR)were analyzed.Results The renal artery blocking time was(34.09±2.84)min during the surgery.The patients’body temperature was(36.10±0.44)℃.The surgical duration was(126.73±47.08)min.The intraoperative bleeding was(81.82±53.07)ml.There were no complications,such as urinary leakage,low body temperature,fever,etc.There was no significant difference between the 3-months postoperative GFR(59.06±25.67)ml/min and preoperative GFR(P=0.636).Conclusions For patients with complex renal tumors,renal arterial cold solution perfusion in robot-assisted laparoscopic partial nephrectomy can help obtain longer operative duration during hot ischemia,preserve renal function,and it provide a safe and feasible surgical method for patients.
作者
杨云开
白宇晨
王晶运
张琦
魏海彬
刘锋
张大宏
Yang Yunkai;Bai Yuchen;Wang Jingyun;Zhang Qi;Wei Haibin;Liu Feng;Zhang Dahong(Department of Urology,Zhejiang Provincial People’s Hospital,Hangzhou 310011,China;Zhejiang Chinese Medical University,Hangzhou 310004,China;Bengbu Medical University,Bengbu 233000,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2022年第11期835-839,共5页
Chinese Journal of Urology
关键词
肾肿瘤
肾部分切除术
低温灌注
机器人辅助腹腔镜手术
疗效
Kidney neoplasms
Partial nephrectomy
Cold perfusion
Robot-assisted laparoscopic surgery
Efficacy
