[1]张洪宪 秦艳春 赵勋 刘茁 赵磊 叶剑飞 王国良 黄毅 马潞林**.不停用抗血小板药物行后腹腔镜肾部分切除术5例[J].中国微创外科杂志,2021,01(5):459-463.
　Zhang Hongxian,Qin Yanchun,Zhao Xun,et al.Retroperitoneal Laparoscopic Partial Nephrectomy Without Ceasing Antiplatelet Drugs: Report of 5 Cases[J].Chinese Journal of Minimally Invasive Surgery,2021,01(5):459-463.
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不停用抗血小板药物行后腹腔镜肾部分切除术5例()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2021年5期
页码:
459-463
栏目:
经验交流
出版日期:
2021-05-25

文章信息/Info

Title:
Retroperitoneal Laparoscopic Partial Nephrectomy Without Ceasing Antiplatelet Drugs: Report of 5 Cases
作者:
张洪宪 秦艳春 赵勋 刘茁 赵磊 叶剑飞 王国良 黄毅 马潞林**
（北京大学第三医院泌尿外科，北京100191）
Author(s):
Zhang Hongxian;  Qin Yanchun;  Zhao Xun;  et al.
Department of Urology, Peking University Third Hospital, Beijing 100191, China
关键词:
肾癌; 肾部分切除; 后腹腔镜; 阿司匹林; 氯吡格雷; 抗血小板治疗
Keywords:
Renal cancer; Partial nephrectomy; Retroperitoneal laparoscopy; Aspirin; Clopidogrel; Antiplatelet therapy
文献标志码:
B
摘要:
目的探讨围手术期不停用抗血小板药物行后腹腔镜肾部分切除术的安全性。方法回顾性分析2017年11月~2019年12月因肾癌行后腹腔镜肾部分切除术519例资料，其中5例因心脑血管疾病需持续应用抗血小板药物（单纯使用阿司匹林3例，同时使用阿司匹林和氯吡格雷2例）。肾肿瘤R.E.N.A.L.评分4分2例，5分2例，8分1例。在不停用抗血小板药物的情况下行后腹腔镜肾部分切除术。结果平均手术时间136.8 min（113~162 min），术中出血量74 ml（20~250 ml），肾动脉阻断时间21.4 min（11~30 min），均无术中和术后输血。术前血红蛋白152 g/L（147~168 g/L），术后第1天1296 g/L（109~149 g/L）。术前血清肌酐72.6 μmol/L（67~81 μmol/L），术后第1天89 μmol/L（73~139 μmol/L）。术后引流管留置时间5 d（4~7 d），总引流量351.4 ml（204~530 ml）。围手术期无心脑血管并发症。术后随访13个月（3~26个月），未见肿瘤复发和转移。结论对于需长期服用抗血小板药物的肾癌患者，经过高度选择的发生心脑血管意外高风险患者不停用抗血小板药物行后腹腔镜肾部分切除术相对安全可靠。
Abstract:
ObjectiveTo explore the safety of retroperitoneal laparoscopic partial nephrectomy without ceasing antiplatelet drugs.MethodsClinical data of 519 cases of renal cancer who underwent retroperitoneal laparoscopic partial nephrectomy from November 2017 to December 2019 were collected, in which 5 patients took oral antiplatelet drugs due to cardiovascular and cerebrovascular disorders. There were 3 cases treated with aspirin alone and 2 cases treated with aspirin and clopidogrel. The R.E.N.A.L. scored 4 points in 2 cases, 5 points in 2 cases, and 8 points in 1 case. Retroperitoneal laparoscopic partial nephrectomy was performed without ceasing antiplatelet drugs.ResultsThe average operation time was 136.8 min (range, 113-162 min). The average intraoperative blood loss was 74 ml (range, 20-250 ml). The average renal artery occlusion time was 21.4 min (range, 11-30 min). There was no intraoperative and postoperative blood transfusion. The hemoglobin was 152 g/L (range, 147-168 g/L) before operation, and 129.6 g/L (range, 109-149 g/L) on the first postoperative day. The serum creatinine was 72.6 μmol/L (range, 67-81 μmol/L) before operation and 89 μmol/L (range, 73-139 μmol/L) on the first postoperative day. The postoperative drainage tube indwelling time was 5 d (range, 4-7 d), and the total drainage volume was 351.4 ml (range, 204-530 ml). There was no cardiovascular or cerebrovascular complications during the perioperative period. After 13 months of followup (range, 3-26 months), there was no tumor recurrence or metastasis.ConclusionFor highly selected patients with high risk of cardiovascular and cerebrovascular accidents, retroperitoneal laparoscopic partial nephrectomy without ceasing antiplatelet drugs is safe and reliable.

参考文献/References:

[1]Global Burden of Disease Cancer Collaboration．Global，regional，and national cancer incidence，mortality，years of life lost，years lived with disability，and disabilityadjusted lifeyears for 29 cancer groups，1990 to 2016.A systematic analysis for the Global Burden of Disease Study.JAMA Oncol,2018,4(11):1553-1568.
[2]Fardoun T,Chaste D,Oger E,et al.Predictive factors of hemorrhagic complications after partial nephrectomy.Eur J Surg Oncol,2014,40:85-89.
[3]Udell JA,Bonaca MP,Collet JP,et al.Longterm dual antiplatelet therapy for secondary prevention of cardiovascular events in the subgroup of patients with previous myocardial infarction:a collaborative metaanalysis of randomized trials.Eur Heart J,2016,37(4):390-399.
[4]Bittl JA,Baber U,Bradley SM,et al.Duration of dual antiplatelet therapy:a systematic review for the 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease:a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines.Circulation,2016,134(10):e156-e178.
[5]Hermiller JB,Krucoff MW,Kereiakes DJ,et al.DAPT Study Investigators.Benefits and risks of extended dual antiplatelet therapy after everolimuseluting stents.JACC Cardiovasc Interv,2016,9(2):138-147.
[6]Hawn MT,Graham LA,Richman JS,et al.Risk of major adverse cardiac events following noncardiac surgery in patients with coronary stents.JAMA,2013,10:1462-1472.
[7]Carneiro A,Cha JD,Baccaglini W,et al.Should aspirin be suspended prior to robotassisted radical prostatectomy?A systematic review and metaanalysis.Ther Adv Urol,2019,11:1756287218816595.
[8]LeyhBannurah SR,Hansen J,Isbarn H,et al.Open and robotic assisted radical retropubic prostatectomy in men with ongoing lowdose aspirin medication:revisiting an old paradigm?BJU Int,2014,114(3):396-403.
[9]Parikh A,Toepfer N,Baylor K,et al.Preoperative aspirin is safe in patients undergoing urologic robotassisted surgery.J Endourol,2012,26(7):852-856.
[10]Althaus AB,Dovirak O,Chang P,et al.Aspirin and clopidogrel during robotic partial nephrectomy:is it safe?Can J Urol,2015,22:7984-7989.
[11]Leavitt DA,Keheila M,Siev M,et al.Outcomes of laparoscopic partial nephrectomy in patients continuing aspirin therapy.J Urol,2016,195:859-864.
[12]Pradere B,Peyronnet B,Seisen T,et al.Impact of anticoagulant and antiplatelet drugs on perioperative outcomes of roboticassisted partial nephrectomy.Urology,2017,99:118-122.
[13]Timothy I,Ithaar HD,Serge G,et al.Perioperative outcomes following partial nephrectomy performed on patients remaining on antiplatelet therapy.J Urol,2017,197:31-36.
[14]张乐飞,易发现.肾部分切除术的研究进展.中国微创外科杂志,2020,20(2):164-167.
[15]刘青林,陈建森.腹腔镜肾部分切除术治疗T1a期肾细胞癌.中国微创外科杂志,2019,19(3):222-224.

备注/Memo

备注/Memo:
基金项目：国家自然科学基金面上项目（91972381）**通讯作者，Email：malulin@medmail.com.cn
更新日期/Last Update: 2021-08-06