摘要
目的 探讨术前选择性动脉栓塞联合腹腔镜肿瘤剜除术治疗肾错构瘤的临床价值。方法2013年7月～2014年11月我科施行腹腔镜保留。肾单位手术治疗肾错构43例，其中术前选择性动脉栓塞19例（栓塞组），未栓塞24例（非栓塞组），比较2组术中出血量、手术时间、热缺血时间、住院时间、并发症发生情况、术后3个月肾功能变化和肿瘤复发情况。结果栓塞组行肿瘤剜除术比例为100％（19／19），非栓塞组62．5％（15／24），无统计学差异（Fisher检验，P=0．105）；栓塞组术中出血量（46．4±20．6）ml，明显少于非栓塞组（89．54-30．4）ml（t=-5．287，P=0．000）；栓塞组手术时间（90．3±21．1）min明显短于非栓塞组（131．74-18．6）min（t=-6．831，P=0．000），热缺血时间（9．5±5．7）min明显短于非栓塞组（24．2±4．8）min（t=-9．181，P=0．000）；栓塞组住院时间（7．7±1．1）d，明显长于非栓塞组（6．3±1．3）d（t=3．748，P=0．000）。栓塞组无严重并发症发生，非栓塞组中尿漏及术区血肿各1例。术后3个月栓塞组血清肌酐（70．1±13．7）μmol／L，明显低于栓塞组（84．2±9．1）μmol／L（t=-4．045，P=0．000）；栓塞组肾小球滤过率（72．6±12．8）ml·min^-1·1．73m^-2，非栓塞组（68．0±10．7）ml·min^-1．73m^-2，无统计学差异（t=1．284，P=0．206）。2组术后平均随访分别8．9月（3～22个月）和7．5月（5～19个月），均无肿瘤复发。结论与单纯腹腔镜肾部分切除术相比，联合选择性动脉栓塞的肿瘤剜除术能减少术中出血量并缩短热缺血时间，从而更好地保护患肾功能，治疗体积较小的肾错构瘤是安全可行的。
Objective To study the initial experience and outcomes of laparoscopic enucleation with preoperative selective arterial embolization （PSAE） for the treatment of renal angiomyolipomas. Methods A total of 43 patients with sporadic renal angiomyolipomas from July 2013 to November 2014 underwent laparoscopic nephron-sparing surgery （NSS）. The patients were divided into either PSAE group （n = 19） or non-PSAE group （n = 24）. The data of patient demographics, success rate of surgery, perioperative complications rate, operating time （OT）, warm ischemia time （WIT）, estimated blood loss （EBL）, length of hospitalization, kidney estimated glomerular filtration rate （eGFR） and serum creatinine （Scr） level over 3 months, and ipsitateral recurrence were collected and compared between the two groups. Results Enucleation was successful in 100% patients （19/19） of the PSAE group and in 62.5% patients （15/24） of the non-PSAE group, with no significant difference （Fisher＇ s test, P = 0. 105 ） The EBL was （46.4 ± 20.6） ml in the PSAE group, which was significantly less than the non-PSAE group [ （89.5 ± 30.4） ml, t = - 5. 287, P = 0. 0001 The OT and WIT were significantly shorter in the PSAE group than those in the non-PSAE group [ （ 90.3 ±21. 1） rain vs. （131.7±18.6） rain, t= -6.831,P=0.000; （9.5 ±5.7） min vs. （24.2 ±4.8） rain, t= -9. 181, P=0.000]. The length of hospitalization was significantly longer in the PSAE group than that in the non-PSAE group [ （7.7 ± 1.1 ） d vs. （6.3 ± 1.3） d, t = 3. 748, P = 0. 000 ]. No severe complications occurred in the PSAE group, whereas the non-PSAE group had 1 case of urinary leakage and 1 case of hematoma. The Scr level over 3 months after surgery was more ideal in the PSAE group （70.1 ± 13.7） μmol/L vs. （84.2 ± 9.1 ） μmol/L, t = -4. 045, P = 0. 000 ]. No statistically significant difference was found in the eGFR between the PSAE group and the non-PSAE group [（72.6±12.8） ml·min-1·1.73 m-2 vs. （68.0±10.7） ni· min -1 1.73 m-2, t= I. 284, P = 0. 206 . No evidence of recurrence was found during follow-up period in tmth groups. Conclusions Laparoscopic enucleation with PSAE is a safe and effective minimally invasive procedure for the treatment of renal angiomyolipomas. As compared to traditional laparoseopic partia] nephreetomy, it has advantages of less WIT, less EBL, and better protection of renal functions. It can be recommended in well-selected patients.
出处
《中国微创外科杂志》
CSCD
北大核心
2016年第2期101-105,共5页
Chinese Journal of Minimally Invasive Surgery
