腹腔镜下肾部分切除术联合改良肾动脉灌注技术治疗复杂性肾肿瘤的疗效分析

王金行; 郭园园; 孙巍; 高五岳; 刘建民; 刘贝贝

doi:10.16766/j.cnki.issn.1674-4152.003146

腹腔镜下肾部分切除术联合改良肾动脉灌注技术治疗复杂性肾肿瘤的疗效分析

doi: 10.16766/j.cnki.issn.1674-4152.003146

蚌埠医学院第一附属医院泌尿外科，安徽蚌埠 233004

基金项目:

安徽省高校自然科学研究项目 KJ2017A244

蚌埠医学院研究生科研创新计划项目 Byycxz22067

蚌埠医学院第一附属医院领先新技术项目 2022094

详细信息

通讯作者:
刘贝贝，E-mail：bb_dynasty@qq.com

中图分类号: R737.11 R730.56
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出版历程
- 收稿日期: 2023-03-03
- 网络出版日期: 2023-10-19

Effect analysis of laparoscopic partial nephrectomy combined with modified renal artery perfusion in the treatment of complex renal tumors

Department of Urology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨改良肾动脉低温灌注技术辅助腹腔镜肾部分切除术(LPN)治疗复杂性肾肿瘤的安全性、可行性及近期疗效。方法选取蚌埠医学院第一附属医院泌尿外科于2021年10月—2022年10月期间行LPN治疗的50例复杂性肾肿瘤患者，其中行LPN联合改良肾动脉低温灌注作为研究组(20例)，未联合改良肾动脉低温灌注作为对照组(30例)。比较2组手术相关指标、肾功能指标及并发症发生情况。对肿瘤旁肾脏正常组织切片进行HE染色，观察镜下组织缺血缺氧变化。结果与对照组比较，研究组肾功能指标术后总GFR下降值、患侧GFR下降值低于对照组[(8.81±2.50)mL/min vs. (14.48±2.90)mL/min，(9.37±2.50)mL/min vs. (14.38±1.80)mL/min，均P＜0.05]；研究组术中肾脏温度、术中出血量明显低于对照组[(21.18±2.34)℃ vs. (32.48±1.13)℃、(105.00±30.17)mL vs. (141.30±57.00)mL，均P＜0.05]；镜下组织HE染色评分研究组低于对照组[(2.98±0.66)分vs. (4.07±0.66)分，P＜0.05]。2组冷灌注/肾动脉阻断时间、体温、手术时间、术后住院时间等比较差异无统计学意义(均P＞0.05)。结论 LPN联合改良肾动脉灌注在治疗复杂性肾肿瘤中可以降低出血量，减轻炎症反应，保护肾功能。
- 腹腔镜肾部分切除术 /
- 肾动脉低温灌注技术 /
- 复杂性肾肿瘤
Abstract: Objective To evaluate the safety, feasibility and short-term efficacy of laparoscopic partial nephrectomy (LPN) combined with modified renal artery perfusion in the treatment of complex renal tumors. Methods Fifty patients with complex renal tumors treated with LPN in the Department of Urology of the First Affiliated Hospital of Bengbu Medical College from October 2021 to October 2022 were selected, in which LPN combined with modified renal artery cryogenic perfusion was used as the study group (20 cases), and not combined with modified renal artery cryogenic perfusion was used as the control group (30 cases). Operation related indexes, renal function indexes and complications were compared between the two groups. H&E staining were performed on the slices of normal kidney tissues adjacent to the tumor to observe the changes of ischemia and hypoxia under the microscope. Results Compared with the control group, the decrease of total GFR and GFR on the affected side of renal function index in the study group after operation were lower [(8.81±2.50) mL/min vs. (14.48±2.90) mL/min, (9.37±2.50) mL/min vs. (14.38±1.80) mL/min, P < 0.01]. The intraoperative renal temperature and blood loss in the study group were significantly lower than those in the control group [(21.18±2.34) ℃ vs. (32.48±1.13) ℃, (105.00±30.17) mL vs. (141.30 ±57.00) mL, all P < 0.05]. Pathological score of microscopic tissue inflammatory changes in the study group was significantly lower than that in the control group [(2.98±0.66) points vs. (4.07±0.66) points, P < 0.05], the expression of IL-18 and NAG in the study group was lower than that in the control group in immunohistochemistry. There were no significant differences in cold perfusion/renal artery occlusion time, body temperature, operation time and postoperative hospital stay between the two groups (all P>0.05). Conclusion LPN combined with modified renal artery perfusion can reduce blood loss, reduce inflammation and protect renal function in the treatment of complex renal tumors.
- Laparoscopic partial nephrectomy /
- Renal artery cryogenic perfusion technique /
- Complex renal tumor

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图 1 改良肾动脉灌注手术示意图及影像资料

注：A示清晰可见动脉导管；B为血管阻断带扎紧血管，阻断肾动脉；C为增强CT中肿瘤明显强化；D为CT血管造影下置入动脉鞘管，肿瘤血供丰富。

Figure 1. Schematic diagram and image data of modified renal artery perfusion surgery

下载: 全尺寸图片幻灯片

图 2 2组不同缺血状态下HE染色切片镜下表现

注：A示周围大量炎症细胞浸润，肾小管刷状缘紊乱；B示肾小管上皮细胞肿胀，上皮细胞形态出现异常，肾小球囊性扩张，间质血管扩张、充血、出血；C示少量炎症细胞浸润，肾小管刷状规整；D示上皮细胞形态正常。

Figure 2. HE staining microscopical findings in 2 groups under different ischemic conditions

下载: 全尺寸图片幻灯片

表 1 2组复杂性肾肿瘤患者一般资料比较

Table 1. Comparison of general data of patients with complex renal tumors in two groups

组别	例数	年龄 (x±s, 岁)	性别(例)		肿瘤部位(例)		RENAL 评分(x±s, 分)	肿瘤直径 (x±s, cm)	TNM分期(例)
组别	例数	年龄 (x±s, 岁)	男性	女性	左	右	RENAL 评分(x±s, 分)	肿瘤直径 (x±s, cm)	T1aN0M0	T1bN0M0	T2aN0M0
研究组	20	65.30±10.13	10	10	9	11	8.81±0.95	5.09±1.50	3	10	7
对照组	30	60.60±11.84	13	17	16	14	8.73±0.91	5.26±1.39	5	16	9
统计量		1.455^a	0.215^b		0.333^b		0.250^a	0.420^a	493.500^c
P值		0.152	0.643		0.564		0.804	0.679	0.711
注：^a为t值，^b为χ²值，^c为T值。

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表 2 2组肾肿瘤患者手术前后Scr与CysC指标比较(x±s)

Table 2. Comparison of Scr and CysC indexes in two groups of renal tumor patients before and after operation

组别	例数	Scr(μmol/L)		t值	P值	CysC(mg/L)		t值	P值
组别	例数	术前	术后	t值	P值	术前	术后	t值	P值
研究组	20	67.80±9.62	82.00±26.89	2.968	0.008	0.94±0.25	1.60±0.38	7.988	0.008
对照组	30	69.37±16.71	90.36±29.54	5.637	0.001	0.92±0.35	1.61±0.41	7.942	0.002
t值		0.379	1.016			0.174	0.108
P值		0.707	0.315			6.826	0.915

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表 3 2组肾肿瘤患者GFR关联指标比较(x±s)

Table 3. Comparison of GFR correlation indexes in two groups of renal tumor patients(x±s)

组别	例数	肾脏温度 (℃)	术中最低体温 (℃)	术中灌注量 (mL)	肾动脉阻断时间(min)	术前总GFR (mL/min)	术后总GFR (mL/min)	总GFR下降值 (mL/min)	患侧GFR下降值(mL/min)
研究组	20	21.18±2.34	36.38±0.13	542.00±35.78	40.15±2.37	70.01±12.46	61.20±11.39	8.81±2.50	9.37±2.50
对照组	30	32.48±1.13	36.36±0.17		39.13±1.56	92.36±12.46	77.89±11.54	14.48±2.90	14.38±1.80
t值		19.668	0.365		1.829	6.214	5.035	7.007	8.226
P值		＜0.001	0.717		0.102	< 0.001	< 0.001	< 0.001	< 0.001

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表 4 2组肾肿瘤患者其他临床资料比较(x±s)

Table 4. Comparison of other clinical data of renal tumor patients in two groups(x±s)

组别	例数	手术时间 (min)	术后住院时间 (d)	术中出血量 (mL)	排气时间 (d)	拔引流管时间 (d)	HE染色评分 (分)
研究组	20	155.00±22.98	8.75±2.10	105.00±30.17	2.85±0.52	6.83±2.36	2.98±0.66
对照组	30	145.57±9.13	7.70±1.50	141.30±57.00	2.90±0.56	6.92±1.16	4.07±0.66
t值		1.747	1.935	2.927	0.318	0.183	8.100
P值		0.094	0.062	＜0.001	0.752	0.856	＜0.001

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