腹腔镜肾部分切除术治疗中高复杂程度肾肿瘤的效果

doi:10.19723/j.issn.1671-167X.2023.05.009

摘要/Abstract

摘要：

目的: 探讨腹腔镜肾部分切除术治疗中高复杂程度(R.E.N.A.L.评分7~10分)肾肿瘤的效果。方法: 选取北京大学第三医院2016年2月至2021年4月行腹腔镜肾部分切除术的R.E.N.A.L.评分为7~10分的肾肿瘤患者186例，所有患者均在完善检查后行腹腔镜肾部分切除术。对患者进行随访，记录术后血红蛋白、血肌酐、并发症、住院时间等。数据用均数±标准差或中位数(范围)表示。结果: 本组男128例、女58例，年龄(54.6±12.8)岁，体重指数(25.4±3.4) kg/m²；肿瘤位于左侧95例、右侧91例，肿瘤最大径(3.1±1.2) cm。患者术前血红蛋白(142.9±15.8) g/L，血肌酐78 μmol/L(47~149 μmol/L)。根据术前CT影像进行R.E.N.A.L.评分：7分43例，8分67例，9分53例，10分23例。所有手术均顺利完成，有12例中转开放手术。手术时间150 min(69~403 min)，热缺血时间25 min(3~60 min)，术中出血量30 mL(5~1 500 mL)，有9例输血，输血量800 mL(200~1 200 mL)。术后血红蛋白(126.2±17.0) g/L，术后血肌酐83.5 μmol/L(35~236 μmol/L)，住院时间6 d(3~26 d)，手术效果达到“三连胜”87例(46.8%)。有167例得到随访，随访时间12个月(1~62个月)，其中复发伴转移1例，转移4例，合并其他肿瘤2例(死亡1例)。结论: 腹腔镜肾部分切除术治疗R.E.N.A.L.评分为7~10分的肾肿瘤是安全且有效的，基于肿瘤的复杂性，随着难度的增加，阻断时间和手术时间有逐渐增加的趋势，“三连胜”比例逐渐降低；腹腔镜肾部分切除术并发症较少，能较好地达到最大限度保留肾功能的目的。

关键词: 肾肿瘤, 腹腔镜检查, 肾部分切除术, 治疗结果

Abstract:

Objective: To investigate the treatment outcome of laparoscopic partial nephrectomy in the patients with renal tumors of moderate to high complexity (R.E.N.A.L. score 7-10). Methods: In the study, 186 patients with a renal score of 7-10 renal tumors who underwent laparoscopic partial nephrectomy in Peking University Third Hospital from February 2016 to April 2021 were selected. Laparoscopic partial nephrectomy was performed after examination. The patients were followed-up, and their postoperative hemoglobin, creatinine, complications, and length of hospital stay recorded. The data were represented by mean±standard deviation or median (range). Results: There were 128 males and 58 females in this group, aged (54.6±12.8) years, with body mass index of (25.4 ± 3.4) kg/m²; The tumors were located in 95 cases on the left and 91 cases on the right, with maximum diameter of (3.1±1.2) cm. The patient's preoperative hemoglobin was (142.9±15.8) g/L, and blood creatinine was 78 μmol/L (47-149 μmol/L). According to preoperative CT images, the R.E.N.A.L. score was 7 points for 43 cases, 8 points for 67 cases, 9 points for 53 cases, and 10 points for 23 cases. All the ope-rations were successfully completed, with 12 cases converted to open surgery. The operation time was 150 minutes (69-403 minutes), the warm ischemic time was 25 minutes (3-60 minutes), and the blood loss was 30 mL (5-1 500 mL). There were 9 cases of blood transfusions, with a transfusion volume of 800 mL (200-1 200 mL). Postoperative hemoglobin was (126.2±17.0) g/L. The preoperative crea-tinine was 78 μmol/L (47-149 μmol/L), the postoperative creatinine was 83.5 μmol/L (35-236 μmol/L), the hospital stay was 6 days (3-26 days), and surgical results achieved "the trifecta" in 87 cases (46.8%). In the study, 167 cases were followed up for 12 months (1-62 months), including 1 case with recurrence and metastasis, 4 cases with metastasis, and 2 cases with other tumors (1 case died). Conclusion: Laparoscopic partial nephrectomy is safe and effective in the treatment of renal tumors with R.E.N.A.L. score of 7-10. Based on the complexity of the tumor, with the increase of difficulty, the warm ischemia time and operation time tend to increase gradually, while "the trifecta" rate gradually decreases. The complications of this operation are less, and the purpose of preserving renal function to the greatest extent is achieved.

Key words: Kidney neoplasms, Laparoscopy, Partial nephrectomy, Treatment outcome

中图分类号:

R737.11

邱敏,宗有龙,王滨帅,杨斌,徐楚潇,孙争辉,陆敏,赵磊,卢剑,刘承,田晓军,马潞林. 腹腔镜肾部分切除术治疗中高复杂程度肾肿瘤的效果[J]. 北京大学学报（医学版）, 2023, 55(5): 833-837.

Min QIU,You-long ZONG,Bin-shuai WANG,Bin YANG,Chu-xiao XU,Zheng-hui SUN,Min LU,Lei ZHAO,Jian LU,Cheng LIU,Xiao-jun TIAN,Lu-lin MA. Treatment outcome of laparoscopic partial nephrectomy in patients with renal tumors of moderate to high complexity[J]. Journal of Peking University (Health Sciences), 2023, 55(5): 833-837.

图/表 1

表1

参考文献 17

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Items	R.E.N.A.L. score
Items	7 (n=43)	8 (n=67)	9 (n=53)	10 (n=23)
Warm ischemia time/min	21 (3-40)	25 (8-40)	26 (12-56)	27 (14-60)
Operation time/min	128 (69-284)	151 (79-370)	156 (87-283)	253 (99-346)
Postoperative hemoglobin decrease/(g/L)	14 (0-26)	20 (6-38)	15 (1-40)	19 (1-64)
Transfusion	1 (2.3)	4 (6.0)	3 (5.7)	1 (4.3)
Length of stay/d	6 (3-8)	6 (3-11)	6 (3-13)	6 (4-11)
Trifecta	27 (62.8)	30 (44.8)	21 (39.6)	9 (39.1)