Objective: To investigate the safety and efficacy of retroperitoneal laparoscopic selective renal artery branch occlusion with nephron sparing surgery in patients with renal carcinoma of stage ≥ T1b. Methods: From July 2016 to September 2020, 35 patients with renal cancer ≥T1b underwent retroperitoneoscopic nephron sparing surgery in the First Affiliated Hospital of Shenzhen University. The surgical methods were retroperitoneoscopic nephron sparing surgery with total renal artery occlusion (group A) or selective renal artery branch occlusion (group B). Operation time, heat ischemia time, blood transfusion rate, positive margin rate, intraoperative blood loss, postoperative complications and length of hospital stay were compared between the two groups, and the total glomerular filtration rate (GFR) and the single-nephron glomerular filtration rate (sGFR) of the offected kidneys were compared between the two groups before, 3 months after and 12 months after surgery. Results: Among the 35 patients, 19 were male and 16 were female, aged (55.7±8.4) years and the body mass index is (24.6±3.1) kg/m2. The tumor diameter was (54.7±10.3) mm. The difference was statistically significant of operative time between group A and B [(103.5±14.3) vs (123.2±14.1) min,P=0.003]. There were no significant differences in thermal ischemia time, blood transfusion rate, positive margin, intraoperative blood loss, incidence of postoperative complications and length of hospital stay between the two groups (all P>0.05). The decrease of renal sGFR in the group A was significantly higher than group B at 3 months and 12 months after surgery [(23.1±3.6) vs (29.1±7.1) ml/min;(25.9±4.7) vs (30.7±7.2),both P<0.05]. Conclusion: Retroperitoneal laparoscopic selective renal artery branch occlusion and neon-sparing surgery for patients with ≥ T1b stage renal carcinoma is a safe and effective surgical method, which can well protect the renal function of patients in the early postoperative stage without increasing intraoperative blood loss and postoperative complications.
目的： 探讨≥T1b期肾癌患者实施后腹腔镜下选择性肾动脉分支阻断保留肾单位手术的安全性和有效性。 方法： 2016年7月至2020年9月，在深圳大学第一附属医院进行后腹腔镜下保留肾单位手术治疗的≥T1b期的肾癌患者35例，分别采用后腹腔镜下肾动脉全阻断（A组）和选择性肾动脉分支阻断（B组）保留肾单位手术，比较两组手术时间、热缺血时间、输血率、切缘阳性率、术中出血量、术后并发症及住院时间，并比较两组患者术前、术后3个月、术后12个月的总肾小球滤过率（GFR）和患肾单侧GFR（sGFR）。 结果： 35例患者中，男19例、女16例；年龄（55.7±8.4）岁；体质指数（24.6±3.1）kg/m2；肿瘤直径（54.7±10.3）mm。A组手术时间短于B组［（103.5±14.3）比（123.2±14.1）min，P=0.003］。两组热缺血时间、输血率、切缘阳性率、术中出血量、术后并发症发生率及住院时间差异均无统计学意义（均P>0.05）。A组术后3个月、术后12个月患肾sGFR较术前下降程度均高于B组［（23.1±3.6）比（29.1±7.1）ml/min；（25.9±4.7）比（30.7±7.2），均P<0.05］。 结论： 分期≥T1b期肾癌患者实施后腹腔镜下选择性肾动脉分支阻断保留肾单位手术是一种安全有效的手术方法，能够在术后早期很好地保护患者患肾功能，且不会增加术中出血量和术后并发症。.