[1]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,(05):413-417.
 CHEN Xianxian,GUAN Yang,FU Jinxin,et al.The application of hypothermic perfusion via renal artery balloon catheter in laparoscopic partial nephrectomy[J].journal interventional radiology,2017,(05):413-417.
点击复制

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


()

PDF下载中关闭

分享到:

《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
期数:
2017年05期
页码:
413-417
栏目:
肿瘤介入
出版日期:
2017-05-25

文章信息/Info

Title:
The application of hypothermic perfusion via renal artery balloon catheter in laparoscopic partial nephrectomy
作者:
陈现现 管 阳 付金鑫 陈 朔 袁 凯 刘 轩 马 鑫 王茂强 刘凤永
Author(s):
CHEN Xianxian GUAN Yang FU Jinxin CHEN Shuo YUAN Kai LIU Xuan MA Xin WANG Maoqiang LIU Fengyong
Department of Interventional Radiology, General Hospital of PLA, Beijing 100853, China
关键词:
【关键词】 球囊导管 低温灌注 肾部分切除术 腹腔镜 数字减影血管造影
文献标志码:
A
摘要:
【摘要】 目的 评价腹腔镜肾部分切除术前行肾动脉球囊导管置入术进行低温灌注的可行性和安全性。方法 选取解放军总医院2013年3月至2016年12月35例拟行腹腔镜肾脏肿瘤部分切除术患者,肿瘤位于左肾22例,右肾13例,肿瘤长径2.3~7.0 cm,平均(4.1±1.2) cm。切除术前行肾动脉球囊导管置入术,术中经球囊导管灌注4℃低温液体,记录切除术中肾脏冷缺血时间,手术时间,术中出血量,比较术前,术后第1、3、7天肌酐清除率(Ccr)和肾小球滤过率估值(eGFR),统计术中及术后并发症。结果35例患者肾动脉球囊导管均置入成功,技术成功率100%。1例患者行切除术前球囊导管滑脱,2例术中发现阻断不全另使用动脉钳阻断,另32例成功行单纯肾动脉球囊导管低温灌注下腹腔镜肾部分切除术,术中及术后均未出现严重并发症。患肾冷缺血时间平均45(20~125) min;介入手术时间平均28(20~40) min;外科手术时间平均147(95~235) min;术中出血量平均180(50~1 000) ml;术前,术后第1、3、7天Ccr分别为(96.5±15.1)、(75.2±10.5)、(54.3±13.8)、(91.8±14.1) ml/min,eGFR分别为(99.5±15.3)、(70.3±12.5)、(65.5±11.7)、(96.8±12.3) ml?min-1?1.73 m-2。经统计分析,术前、术后第7天Ccr和eGFR值分别同术后第1、3天值相比较,两组均存在统计学差异(P<0.01),术前同术后第7天比较,两组均无明显统计学差异(P>0.05)。结论 腹腔镜肾部分切除术前行肾动脉球囊导管低温灌注安全、可行,有利于延长肾缺血时间、保护肾功能。

参考文献/References:

[1] Hinata N, Fujisawa M. Current status of robotic partial nephrectomy in Japan[J]. Investig Clin Urol, 2016, 57(Suppl 2): s121- s129.
[2] Gu L, Ma X, Li H, et al. Comparison of oncologic outcomes between partial and radical nephrectomy for localized renal cell carcinoma: a systematic review and meta- analysis[J]. Surg Oncol, 2016, 25: 385- 393.
[3] Ertemi H, Khetrapal P, Pavithran NM, et al. Optimising renal cancer patients for nephron- sparing surgery: a review of pre- operative considerations and peri- operative techniques for partial nephrectomy[J]. Urologia, 2017, 84: 20- 27.
[4] Finelli A, Ismaila N, Bro B, et al. Management of small renal masses: American Society of Clinical Oncology clinical practice guideline[J]. J Clin Oncol, 2017, 35: 668- 680.
[5] Novara G, La Falce S, Kungulli A, et al. Robot- assisted partial nephrectomy[J]. Int J Surg, 2016, 36: 554- 559.
[6] Power NE, Silberstein JL, Touijer K. Is laparoscopic partial nephrectomy already the gold standard for small renal masses?[J]. Arch Esp Urol, 2013, 66: 90- 98.
[7] Lopes RI, Ming J, Koyle MA, et al. “Zero- ischemia” laparoscopic- assisted partial nephrectomy for the management of selected children with Wilms tumor following neoadjuvant chemotherapy[J]. Urology, 2017, 100: 103- 110.
[8] 欧阳强, 董伟华, 肖湘生. 移植肾动脉狭窄的介入治疗[J]. 介入放射学杂志, 2008, 17: 853- 857.
[9] 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: 80- 83.
[10] Sanchez- Zalabardo D, Millan- Serrano JA, De Pablo- Cardenas A, et al. Treatment of locally advanced renal tumors[J]. Actas Urol Esp, 2010, 34: 134- 141.
[11] Klatte T, Shariat SF, Remzi M. Systematic review and meta- analysis of perioperative and oncologic outcomes of laparoscopic cryoablation versus laparoscopic partial nephrectomy for the treatment of small renal tumors[J]. J Urol, 2014, 191: 1209- 1217.
[12] Oh JJ, Byun SS, Lee SE, et al. Partial nephrectomy versus radical nephrectomy for non- metastatic pathological T3a renal cell carcinoma: a multi- institutional comparative analysis[J]. Int J Urol, 2014, 21: 352- 357.
[13] Li HK, Chung HJ, Huang EY, et al. Impact of warm ischemia time on the change of split renal function after minimally invasive partial nephrectomy in Taiwanese patients[J]. J Chin Med Assoc, 2015, 78: 62- 66.
[14] Becker F, Van Poppel H, Hakenberg OW, et al. Assessing the impact of ischaemia time during partial nephrectomy[J]. Eur Urol, 2009, 56: 625- 634.
[15] Porpiglia F, Renard J, Billia M, et al. Is renal warm ischemia over 30 minutes during laparoscopic partial nephrectomy possible? One- year results of a prospective study[J]. Eur Urol, 2007, 52: 1170- 1178.
[16] Micali S, Silver RI, Kaufman HS, et al. Measurement of urinary N- acetyl- beta- D- glucosaminidase to assess renal ischemia during laparoscopic operations[J]. Surg Endosc, 1999, 13: 503- 506.
[17] Marberger M, Eisenberger F. Regional hypothermia of the kidney: surface or transarterial perfusion cooling? A functional study[J]. J Urol, 1980, 124: 179- 183.
[18] Ozkan U, Oguzkurt L, Tercan F, et al. Renal artery origins and variations: angiographic evaluation of 855 consecutive patients[J]. Diagn Interv Radiol, 2006, 12: 183- 186.
[19] 解 阳, 顾俊鹏, 张海潇, 等. 脾动脉阻断联合射频消融术治疗脾功能亢进的疗效观察[J]. 介入放射学杂志, 2015, 24: 405- 408.

相似文献/References:

[1]刘琳香.导管顶端封堵健侧宫角液体加压法联合导丝再通术在单侧输卵管阻塞中的应用[J].介入放射学杂志,2018,27(01):50.
 LIU Linxiang.Application of liquid pressurization under obstruction of healthy- side uterine horn with catheter tip combined with guidewire recanalization in treating unilateral obstruction of fallopian tube[J].journal interventional radiology,2018,27(05):50.

备注/Memo

备注/Memo:
(收稿日期:2016-08-26)
(本文编辑:俞瑞纲)
更新日期/Last Update: 2017-05-15