| 摘要: |
| 目的 探讨"蛙跳式"选择性肾动脉阻断法在腹腔镜保留肾单位手术中的临床应用。方法 2014年8月至2015年8月,对5对尸体肾脏和20个行肾切除术的肾脏进行肾动脉血管解剖,观察动脉的分支走行及其与肾门的位置关系,研究选择性肾动脉阻断法的解剖学基础。回顾性分析10例腹腔镜保留肾单位手术,其中5例采用"蛙跳式"选择性分支动脉阻断法,另外5例随机选取同期行传统选择性分支动脉阻断法的病例,分别记录游离肾脏肿瘤后至阻断分支动脉的时间和热缺血时间,初步研究"蛙跳式"选择性分支动脉阻断法的临床应用效果。结果 5对尸体肾脏和20个肾切除术后的肾脏中分别有72.2%(39/54)和70.8%(68/96)的分支动脉沿着肾门"门框"处进入肾脏。临床应用方面,10例腹腔镜保留肾单位手术均安全顺利完成。5例行"蛙跳式"肾动脉阻断的患者中有1例因分支动脉阻断效果不理想,更改为阻断肾动脉主干。传统和"蛙跳式"选择性分支动脉阻断法游离肾脏肿瘤后至阻断分支动脉的时间分别为10~18 min和6~11 min,热缺血时间分别为15~25 min和14~26 min。结论 "蛙跳式"选择性分支动脉阻断法不仅可减少肾功能的损伤,且操作更简单、具有可重复性,危险性更低,对术者的操作技术要求较传统分支动脉阻断法的要求更低,更利于推广。 |
| 关键词: 保留肾单位手术 肾动脉 分支动脉 热缺血 选择性阻断 |
| DOI：10.16781/j.0258-879x.2016.02.0133 |
| 投稿时间：2015-11-23修订日期：2016-01-06 |
| 基金项目:第二军医大学长海医院"1255"基金项目(CH125512106). |
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| Application of an “island hopping” approach in laparoscopic partial nephrectomy for clamping tumor-specific renal arterial branches |
| GUO FeiΔ,YANG BoΔ,YANG Qing,GAO Xiao-feng,ZHANG Chao,WANG Hui-qing,LI Ling,PENG Yong-han,SUN Ying-hao* |
(Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
△Co-first authors
* Corresponding author) |
| Abstract: |
| Objective To study the feasibility and safety of an "island hopping" approach in segmental renal artery dissection and clamping in laparoscopic partial nephrectomy. Methods Between August 2014 and August 2015, 10 cadaveric kidneys and 20 kidneys from radical nephrectomy were used to dissect the renal arteries. The route of renal artery branches and its relationship with location of the renal hilum were observed and recorded. A retrospective analysis was made for 10 patients undergoing laparoscopic partial nephrectomy using traditional superselective artery clamping method (n=5) or "island hopping" superselective artery clamping method (n=5). The time of dissecting the segmental arteries and the warm ischemia time were recorded, and the clinical efficacy of "island hopping" superselective artery clamping method was evaluated. Results For cadaveric kidneys, 72.2%(39/54) of the renal artery branches entered the kidney along the edge of renal hilum, and the number was 70.8% (68/96) in the 20 kidneys from radical nephrectomy. Clinically the laparoscopic partial nephrectomy procedures were successful in all the 10 patients. One of the 5 cases receiving "island hopping" approach were converted to hilus clamping due to poor operation field for tumor resection. Compared with patients undergoing traditional superselective artery clamping, those undergoing "island hopping" approach had a shorter time of dissecting segmental arteries (6-11 min vs 10-18 min) and a similar warm ischemia time (14-26 min vs 15-25 min). Conclusion The "island hopping" approach for tumor-specific renal arterial branches clamping is safe and feasible, and also makes it easier for manipulation, leading to convenient popularization. |
| Key words: nephron-sparing surgery renal artery arterial branches warm ischemia superselective clamping |
