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目的:初步评估选择性肾段动脉阻断的后腹腔镜肾部分切除术的可行性和安全性。方法:采用后腹腔镜下结合术前血管三维成像及术中探查,分离并选择性临时阻断肾肿瘤的供血肾段动脉,对23例单发肾肿瘤患者行肾部分切除术。统计手术时间、术中出血量、肾段动脉阻断时间及围术期并发症。术后1、6个月随访行CT检查及血清肌酐,GRF测算,部分患者行SPECT复查。结果:23例手术均于腔镜下完成,其中2例行双支肾段动脉阻断,2例加行肾动脉主干阻断,15例行集合系统修复,5例缝合开放的可见血管。平均手术时间144min,平均肾段动脉阻断时间26min,平均出血量65ml。肾癌、错构瘤及肾脓肿分别为17、5、1例,均无切缘阳性。漏尿15天并伤口感染1例,23例均无术后继发出血,初步随访无肿瘤局部复发,无尿外渗,肾功能无显著变化。结论:选择性段动脉阻断的后腹腔镜肾部分切除术,术中出血较少,病灶切缘和集合系统辨认清晰;避免了患肾余留组织的热缺血及缺血后再灌注损伤,最大限度保留了肾功能。初步观察手术安全可行。
Objective: To evaluate the feasibility and safety of retroperitoneoscopic partial nephrectomy for selective renal artery occlusion. Methods: Retroperitoneal laparoscopic preoperative blood vessel imaging and intraoperative exploration were used to separate and selectively block the donor renal arteries of the renal tumor. The partial nephrectomy was performed on 23 patients with single renal cell carcinoma. Statistical operation time, intraoperative blood loss, renal artery occlusion time and perioperative complications. Six months follow-up postoperative CT and serum creatinine, GRF estimates, some patients underwent SPECT review. Results: Twenty - three cases underwent endoscopic surgery were performed. Among them, 2 cases were blocked by the branch of the renal arteries, 2 cases were blocked by the trunk of the renal artery, 15 cases were treated by the collecting system and 5 cases were visible sutured open vessels. The average operation time 144min, the average renal artery occlusion time 26min, the average amount of bleeding 65ml. Renal cancer, hamartoma and renal abscess were 17,5,1 cases, no positive margins. Urine leakage for 15 days and wound infection in 1 case, 23 cases were no postoperative bleeding, no recurrence of tumor at the initial follow-up, no urine extravasation, no significant changes in renal function. CONCLUSION: Retroperitoneoscopic partial nephrectomy with selective segmental artery occlusion has less bleeding during operation and clears the margin and collection system of the lesion. It avoids hot ischemia and reperfusion injury after ischemia , To maximize the retention of renal function. Preliminary observation of safe and feasible surgery.