肾周冰盐水降温法在腹腔镜肾部分切除术中的应用
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摘要
目的评价肾周冰盐水降温法在腹腔镜肾部分切除术中对肾功能的保护作用及可行性。方法选取通辽市医院2016年12月至2018年5月7例拟行腹腔镜肾部分切除术的患者,术中阻断肾动脉后用腹腔镜吸引器注入4℃冰盐水500 mL,在冷缺血状态下将肿瘤切除,缝合创面,术中记录肾脏冷缺血的时间,手术时间,术中出血量,记录术后1 d、7 d、1月、3月肌酐清除率并与术前比较。结果 7例患者肾脏肿瘤全部在冷缺血状态下完整切除,冷缺血时间平均43(28-95)min;手术时间平均145(110-185)min;术中出血量平均55(20-250)mL;术前、术后1 d、7 d、1个月、3个月肌酐清除率见表1。经统计学分析,术后第1 d、7 d肌酐清除率与术前值相比较,有显著增高(P<0.05),术后1个月、3个月的肌酐清除率与术前值相比较,均无显著性差异(P> 0.05)。结论肾周冰盐水降温法在腹腔镜肾部分切的应用中是一种安全,可行的方法,可较好的保护肾单位及肾功能,且大大减少了手术时间和手术并发症的发生。
Objective To evaluate protective effect and feasibility of perinephric ice-saline cooling method on renal function in laparoscopic partial nephrectomy. Methods Choose 7 cases laparoscopic partial nephrectomy patients in Tongliao Hospital from December 2016 to May 2018. After blocking renal artery during surgery, inject 500 mL iced saline with laparoscopic aspirator. Under cold ischemia condition, remove tumors and suture wounds. Record cold ischemia time, operation time, intraoperative bleeding volume during surgery. Record creatinine removal rate 1 day,7 days, 1 month and 3 months after operation, compare them with those before operation. Results All renal tumors were completely resected under cold ischemia for 7 patients, with average cold ischemia time of 43(28-95) minutes;average operation time of 145(110-185) minutes; average intraoperative bleeding amount of 55(20-250) mL; creatinine removal rate 1 day, 7 days, 1 month and 3 months before and after operation was showed in Table 1. Statistical analysis showed creatinine removal rate 1 day and 7 day after operation was significantly higher than before operation(P< 0.05).Creatinine removal rate 1 month and 3 months after operation showed no significant difference from that before operation(P> 0.05). Conclusion Perinephric ice-saline cooling method is safe and feasible in laparoscopic partial nephrectomy, which can protect renal unit and function well, and reduce operation time and complications greatly.
Objective To evaluate protective effect and feasibility of perinephric ice-saline cooling method on renal function in laparoscopic partial nephrectomy. Methods Choose 7 cases laparoscopic partial nephrectomy patients in Tongliao Hospital from December 2016 to May 2018. After blocking renal artery during surgery, inject 500 mL iced saline with laparoscopic aspirator. Under cold ischemia condition, remove tumors and suture wounds. Record cold ischemia time, operation time, intraoperative bleeding volume during surgery. Record creatinine removal rate 1 day,7 days, 1 month and 3 months after operation, compare them with those before operation. Results All renal tumors were completely resected under cold ischemia for 7 patients, with average cold ischemia time of 43(28-95) minutes;average operation time of 145(110-185) minutes; average intraoperative bleeding amount of 55(20-250) mL; creatinine removal rate 1 day, 7 days, 1 month and 3 months before and after operation was showed in Table 1. Statistical analysis showed creatinine removal rate 1 day and 7 day after operation was significantly higher than before operation(P< 0.05).Creatinine removal rate 1 month and 3 months after operation showed no significant difference from that before operation(P> 0.05). Conclusion Perinephric ice-saline cooling method is safe and feasible in laparoscopic partial nephrectomy, which can protect renal unit and function well, and reduce operation time and complications greatly.
引文
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[10]马鑫,刘新,郑涛,等.肾动脉低温灌注联合腹腔镜肾部分切除术处理复杂肾肿瘤的初步经验[J].微创泌尿外科杂志,2014,3(02):80-83.
[11]刘新,马鑫,张旭.低温技术在腹腔镜肾部分切除术中的应用[J].微创泌尿外科杂志,2014,3(02):125-128.
[12]徐华敏,胡宇坤.局部低温下单孔后腹腔镜肾部分切除术的手术配合[J].西南军医,2013,15(04):453-455.
[2]夏国伟,孙传玉,丁强.腹腔镜肾部分切除术相关问题探讨[J].微创泌尿外科杂志,2012,1(01):6-8.
[3]Becker F,Van poppel H,Hakenberg OW,et al.Aaaessing the Impact of ischemia time during partial nephrectomy[J].Eur Urol,2009,56(4):625-634.
[4]黄建生,杨江根.腹腔镜肾部分切除术中肾低温保护现状[J].临床泌尿外科杂志,2011,26(02):150-152.
[5]方群鹰,张雪培.低温保护技术在腹腔镜肾部分切除术中的应用进展[J].中国微创外科杂志,2013,13(05):461-463.
[6]朱达伟,刘川,胡自力,等.肾周冰水低温技术在后腹腔镜肾部分切除术中的价值[J].山西医科大学学报,2018,49(04):418-421.
[7]陈现现,管阳,付金鑫,等.肾动脉球囊导管低温灌注在腹腔镜肾部分切除术中的应用[J].介入放射学杂志,2017,26(05):413-417.
[8]李真.比较原位低温与常温下行后腹腔镜肾部分切除术对术后患侧肾功能的影响[D].福建医科大学,2016.
[9]徐杰.低温保护下与常温腹腔镜肾部分切除术围手术期的对比研究[D].福建医科大学,2015.
[10]马鑫,刘新,郑涛,等.肾动脉低温灌注联合腹腔镜肾部分切除术处理复杂肾肿瘤的初步经验[J].微创泌尿外科杂志,2014,3(02):80-83.
[11]刘新,马鑫,张旭.低温技术在腹腔镜肾部分切除术中的应用[J].微创泌尿外科杂志,2014,3(02):125-128.
[12]徐华敏,胡宇坤.局部低温下单孔后腹腔镜肾部分切除术的手术配合[J].西南军医,2013,15(04):453-455.