后腹腔镜下选择性肾动脉栓塞与肾动脉阻断行肾错构瘤剜切除术的比较
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摘要
目的比较后腹腔镜下选择性肾动脉栓塞与肾动脉阻断行肾错构瘤剜切除术的安全性及有效性。方法分析我院2010年1月至2015年12月行腹腔镜下肾错构瘤切除患者的临床资料,共163例,其中选择性肾动脉栓塞后肿瘤吸引及剜除33例,肾动脉阻断肿瘤切除130例,术中行冰冻检查27例,比较两种术式在手术时间、术中出血、术后出血、住院时间等方面的差异。结果所有病例一期在腹腔镜下完成肿瘤切除,介入后肿瘤剜除或吸出33例,术中出血(ml)、手术时间(min)、术后住院时间(d)和费用(万元)分别为:(41±13)、(47±15)、(3.50±0.24)、(1.63±0.29);动脉阻断组130例,相应指标分别为:(83±23)、(103±22)、(4.50±0.31)、(1.23±0.35),术后出血7例,栓塞止血3例,两组比较,介入组优势明显,差异显著(P<0.05)。术后病理诊断透明细胞癌5例(3.1%),术前、术后总肾功能差异无统计学意义(P>0.05),随访期间均无肿瘤复发。结论肾错构瘤选择性肾动脉栓塞后腹腔镜下切除,可以有效降低手术难度、缩短手术时间、减少术中及术后出血风险,有条件的医疗机构值得借鉴。
Objective To compare the safty and clinical efficacy of retroperitoneal laparoscopic excision after selective arterial embolization(SAE) and nonSAE in renal angiomyolipoma. Methods The clinical data of 163 patients with renal angiomyolipoma received retroperitoneal laparoscopy were enrolled from January 2010 to December 2015 in our hospital. The patients were divided into retroperitoneal laparoscopic enucleation with selective arterial embolization group(SAE group, n=33) or tumor resection with renal arterial embolization group(non SAE group, n=130). Twenty seven cases were carried out frozensection examination during operation. The differences of operative time, intra-and post-operation blood loss,length of hospitalization between the two groups were compared. Results All the patients underwent the operation successfully. Intraoperative bleeding(ml), operation time(min), postoperative length of stay(d) and cost(ten thousand yuan) of SAE group were:(41±13),(47±15),(3.50±0.24),(1.63±0.29); non SAE group were:(83±23),(103±22),(4.50±0.31),(1.23±0.35). Seven patients suffered postoperative hemorrhage and 3 were hemostasia with embolization. To compare the clinical efficacy, SAE group was slightly superior to non SAE with significant difference(P<0.05). Five cases(3.1%) were diagnosed with clear cell carcinoma by postoperative pathology. There was no significant difference in total renal function before and after operation. No tumor recurrence was observed during follow-up in two groups. Conclusions Retroperitoneal laparoscopic enucleation with selective arterial embolization in renal angiomyolipoma patients can reduce operation difficulty, shorten operation time, decrease the risk of intra-and post-operation bleeding, which can be apply in wconditional medical institutions.
Objective To compare the safty and clinical efficacy of retroperitoneal laparoscopic excision after selective arterial embolization(SAE) and nonSAE in renal angiomyolipoma. Methods The clinical data of 163 patients with renal angiomyolipoma received retroperitoneal laparoscopy were enrolled from January 2010 to December 2015 in our hospital. The patients were divided into retroperitoneal laparoscopic enucleation with selective arterial embolization group(SAE group, n=33) or tumor resection with renal arterial embolization group(non SAE group, n=130). Twenty seven cases were carried out frozensection examination during operation. The differences of operative time, intra-and post-operation blood loss,length of hospitalization between the two groups were compared. Results All the patients underwent the operation successfully. Intraoperative bleeding(ml), operation time(min), postoperative length of stay(d) and cost(ten thousand yuan) of SAE group were:(41±13),(47±15),(3.50±0.24),(1.63±0.29); non SAE group were:(83±23),(103±22),(4.50±0.31),(1.23±0.35). Seven patients suffered postoperative hemorrhage and 3 were hemostasia with embolization. To compare the clinical efficacy, SAE group was slightly superior to non SAE with significant difference(P<0.05). Five cases(3.1%) were diagnosed with clear cell carcinoma by postoperative pathology. There was no significant difference in total renal function before and after operation. No tumor recurrence was observed during follow-up in two groups. Conclusions Retroperitoneal laparoscopic enucleation with selective arterial embolization in renal angiomyolipoma patients can reduce operation difficulty, shorten operation time, decrease the risk of intra-and post-operation bleeding, which can be apply in wconditional medical institutions.
引文
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[4]卢永宁,张帆,胡骁轶,等.经腰小切口保留肾单位手术治疗完全内生型肾肿瘤临床观察[J].中华医学杂志,2017,97(28):2202-2204.
[5]张建平,刘宇军,林宗明,等.肾部分切除术后迟发性出血的治疗及其高危因素分析[J/CD].泌尿外科杂志(电子版),2015,7(3):36-39,46.
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[8]魏澎涛,乔保平,张寒,等.高选择性肾动脉阻断技术在腹腔镜下保留肾单位手术中的应用研究[J].中国内镜杂志,2018,24(1):56-59.
[9]林明恩,洪英楷,何学军,等.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[J].局解手术学杂志,2016,25(12):911-914.
[10]王栋,纪志刚,李汉忠,等.术前选择性动脉栓塞联合腹腔镜肿瘤剜除术在肾错构瘤中的应用[J].中国微创外科杂志,2016,16(2):101-105.
[11]Wang D,Li HZ,Ji ZG.Effectiveness and safety of laparoscopic enucleation combined with selective arterial embolization for renal angiomyolipoma[J].Cancer Biomark,2017,19(2):177-183.
[12]Bardin F,Chevallier O,Bertaut A,et al.Selective arterial embolization of symptomatic and a symptomaticrenal angiomyolipomas:a retrospective study of safety,outcomes and tumor size reduction[J].Quant Imaging Med Surg,2017,7(1):8-23.
[13]Qin C,Wang Y,Li P,et al.Super-selective artery embolization before laparoscopic partial nephrectomy in treating renal angiomyolipoma[J].Urol Int,2017,99(3):277-282.
[14]Volpe A,Blute ML,Ficarra V,et al.Renal ischemia and function after partial nephrectomy:a collaborative review of the literature[J].Eur Urol,2015,68(1):61-74.
[15]Rod X,Peyronnet B,Seisen T.Impact of ischaemia time on renal function after partial nephrectomy:a systematic review[J].BJU Int,2016,118(5):692-705.
[16]Dong W,Wu J,Suk-Ouichai C,et al.Ischemia and functional recovery from partial nephrectomy:refined perspectives[J].Eur Urol Focus,2017,4(4):572-578.
[2]Sivalingam S,Nakada SY.Contemporary minimally invasive treatment options for renal angiomyolipomas[J].Curr Urol Rep,2013,14(2):147-153.
[3]闫永吉,李炯明,刘建和,等.后腹腔镜肾错构瘤剜除术:附15例报告[J/CD].中华腔镜泌尿外科杂志(电子版),2011,5(3):186-188.
[4]卢永宁,张帆,胡骁轶,等.经腰小切口保留肾单位手术治疗完全内生型肾肿瘤临床观察[J].中华医学杂志,2017,97(28):2202-2204.
[5]张建平,刘宇军,林宗明,等.肾部分切除术后迟发性出血的治疗及其高危因素分析[J/CD].泌尿外科杂志(电子版),2015,7(3):36-39,46.
[6]孟一森,范宇,李德润,等.后腹腔镜下肾部分切除术治疗直径>4 cm肾癌的临床分析[J].中华泌尿外科杂志,2013,34(11):805-809.
[7]Gill IS,Kavoussi LR,Lane BR,et al.Comparison of 1,800laparoscopic and open partial nephrectomies for single renal tumors[J].J Urol,2007,178(1):41-46.
[8]魏澎涛,乔保平,张寒,等.高选择性肾动脉阻断技术在腹腔镜下保留肾单位手术中的应用研究[J].中国内镜杂志,2018,24(1):56-59.
[9]林明恩,洪英楷,何学军,等.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[J].局解手术学杂志,2016,25(12):911-914.
[10]王栋,纪志刚,李汉忠,等.术前选择性动脉栓塞联合腹腔镜肿瘤剜除术在肾错构瘤中的应用[J].中国微创外科杂志,2016,16(2):101-105.
[11]Wang D,Li HZ,Ji ZG.Effectiveness and safety of laparoscopic enucleation combined with selective arterial embolization for renal angiomyolipoma[J].Cancer Biomark,2017,19(2):177-183.
[12]Bardin F,Chevallier O,Bertaut A,et al.Selective arterial embolization of symptomatic and a symptomaticrenal angiomyolipomas:a retrospective study of safety,outcomes and tumor size reduction[J].Quant Imaging Med Surg,2017,7(1):8-23.
[13]Qin C,Wang Y,Li P,et al.Super-selective artery embolization before laparoscopic partial nephrectomy in treating renal angiomyolipoma[J].Urol Int,2017,99(3):277-282.
[14]Volpe A,Blute ML,Ficarra V,et al.Renal ischemia and function after partial nephrectomy:a collaborative review of the literature[J].Eur Urol,2015,68(1):61-74.
[15]Rod X,Peyronnet B,Seisen T.Impact of ischaemia time on renal function after partial nephrectomy:a systematic review[J].BJU Int,2016,118(5):692-705.
[16]Dong W,Wu J,Suk-Ouichai C,et al.Ischemia and functional recovery from partial nephrectomy:refined perspectives[J].Eur Urol Focus,2017,4(4):572-578.