[1]干思舜,王磊,叶剑青,等.超选择性肾动脉栓塞在腹腔镜下零缺血肾癌肾部分切除术中的应用[J].中国微创外科杂志,2018,18(9):810-813.
　Gan Sishun,Wang Lei,Ye Jianqing,et al.Application of Superselective Embolization of Renal Tumors in Zero Ischemia Laparoscopic Partial Nephrectomy[J].Chinese Journal of Minimally Invasive Surgery,2018,18(9):810-813.
点击复制

超选择性肾动脉栓塞在腹腔镜下零缺血肾癌肾部分切除术中的应用()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
18
期数:
2018年9期
页码:
810-813
栏目:
临床研究
出版日期:
2018-12-06

文章信息/Info

Title:
Application of Superselective Embolization of Renal Tumors in Zero Ischemia Laparoscopic Partial Nephrectomy
作者:
干思舜; 王磊; 叶剑青; 田毅君; 曲发军; 储传敏; 杨炜; 崔心刚**
第二军医大学第三附属医院泌尿外科，上海 201805
Author(s):
Gan Sishun;  Wang Lei;  Ye Jianqing;  et al.
Department of Urology, Third Affiliated Hospital, Second Military Medical University, Shanghai 201805, China
关键词:
栓塞; 肾癌; 腹腔镜肾部分切除术; 零缺血
Keywords:
Embolization; Renal cancer; Laparoscopic partial nephrectomy; Zero ischemia
文献标志码:
A
摘要:
目的探讨T1期肾癌术前DSA超选择性肾动脉栓塞后行腹腔镜下零缺血肾部分切除术的可行性与安全性。方法2015年11月~2016年9月13例T1N0M0期肾癌术前由同一介入科医师行肿瘤供血动脉DSA超选择性肾动脉栓塞，栓塞后1~15 h由同一个泌尿外科医生行腹腔镜下零缺血肾部分切除术。结果13例均在腹腔镜下完成手术，无中转开放手术。2例因术中出血较多行肾动脉主干暂时性阻断，阻断时间分别为8、12.5 min，其余11例均按预期顺利完成手术，无输血。平均手术时间82 min（48~125 min），平均出血量130 ml（40~260 ml）。术后病理均为肾透明细胞癌。13例术后平均随访145月（12~18个月），均未见肿瘤复发和（或）转移。结论T1期肾癌术前DSA超选择性肾动脉栓塞后行腹腔镜下零缺血肾部分切除术是安全可行的，尤其对于孤立肾肿瘤、肾功能不全以及引起肾功能下降的慢性病患者是较好的选择，值得推广。
Abstract:
ObjectiveTo discuss the feasibility and safety of zero ischemia laparoscopic partial nephrectomy after preoperative superselective transarterial embolization of the T1 renal cancer.MethodsWe retrospectively analyzed the data of 13 patients who accepted zero ischemia laparoscopic partial nephrectomy after superselective transarterial embolization from November 2015 to September 2016. All tumors were stage T1N0M0, with an average diameter of 4.2 cm (range, 4.0-5.5 cm). The superselective transarterial embolization was performed by the same interventional practitioner, and the zero ischemia laparoscopic partial nephrectomy was carried out by the same surgeon in 1-15 hours after superselective transarterial embolization.ResultsLaparoscopic partial nephrectomy was completed in all the patients. There was no conversion to open surgery. Because of hemorrhage the renal arterial trunk was temporarily blocked for 8 minutes and 12.5 minutes in 2 cases, and the remaining 11 cases were all operated smoothly. The blood transfusion was not needed. The average operation time was 82 minutes (range, 48-125 minutes). The average blood loss was 130 ml (range, 40-260 ml). The average follow-up time was 14.5 months (range, 12-18 months). No reccurence or metastasis occurred.ConclusionIt is a safe and feasible procedure for zero ischemia laparoscopic partial nephrectomy after preoperative superselective transarterial embolization of the T1 renal tumor, especially for patients combined with isolated renal tumor, renal insufficiency, and chronic diseases leading to renal dysfunction.

参考文献/References:

[1]Siegel RL，Miller KD，Jemal A．Cancer statistics, 2015. CA Cancer J Clin,2015,65 (1):5-29．
[2]马超光，闫成智.3D腹腔镜肾部分切除术治疗肾肿瘤（附11例报告）.中国微创外科杂志，2017，17（8）：704-706.
[3]Lane BR，Campbell SC，Gill IS．10-year oncologic outcomes after laparoscopic and open partial nephrectomy．J Urol,2013,190 (1):44-49．
[4]D’Urso L, Simone G, Rosso R, et al. Benefits and shortcomings of superselective transarterial embolization of renal tumors before zero ischemia laparoscopic partial nephrectomy. EJSO,2014,40(12):1731-1737.
[5]Gallucci M, Guaglianone S, Carpanese L, et al. Superselective embolization as first step of laparoscopic partial nephrectomy. Urology,2007,69(4):642-646.
[6]Rais-Bahrami S, George AK, Herati AS, et al. Off-clamp versus complete hilar control laparoscopic partial nephrectomy: comparison by clinical stage. BJU Int,2011,109 (9):1376-1381.
[7]Gill IS, Patil MB, Abreu AL, et al. Zero ischemia anatomical partial nephrectomy: a novel approach. J Urol,2012,187(3):807-814.
[8]Gill I, Eisenberg MS, Aron M, et al. “Zero ischemia” partial nephrectomy:novel laparoscopic and robotic technique. Eur Urol,2011,59(1):128-134.
[9]Shao P, Qin C, Yin C, et al. Laparoscopic partial nephrectomy with segmental renal artery clamping: technique and clinical outcomes. Eur Urol,2011,59 (5):849-855.
[10]Shao P, Tang L, Li P, et al. Precise segmental renal artery clamping under the guidance of dual-source computed tomography angiography during laparoscopic partial nephrectomy. Eur Urol,2012,62(6):1001-1008.
[11]王昕凝，罗光达，刘圣圳，等.机器人辅助腹腔镜肾部分切除术：单一术者99例经验总结.中国微创外科杂志，2017，17（3）：206-209.
[12]Gu L, Ma X, Li H,et al. External validation of the arterial based complexity (ABC) scoring system in renal tumors treated by minimally invasive partial nephrectomy. J Surg Oncol,116(4):507-514.

备注/Memo

备注/Memo:
基金项目：上海市科委医学引导类科技支撑项目（17411960200）；上海市卫计委青年项目（20174Y0175）**通讯作者，E-mail：cuixingang@163.com
更新日期/Last Update: 2018-12-06