摘要目的 探讨选择性肾段动脉阻断的肾部分切除术的临床疗效.方法 回顾性分析郑州大学第一附属医院2008年1月至2012年1月收治的24例行选择性肾段动脉阻断的保留肾单位手术的T1期肾癌患者的临床资料.24例中孤立肾肾癌2例,对侧肾有病变或有潜在功能受损的肾癌6例,对侧肾功能正常的肾癌16例.肿瘤位于肾上段8例,肾下段7例,肾上前段2例,肾下前段2例,后段2例,位于肾上段及上前段3例.外生型20例,内生型4例.肿瘤直径2.2～6.8 cm,平均4.2 cm.术前血肌酐值平均为80μmol/L(67 ～ 110μmol/L).结果 手术均顺利完成,平均出血80 ml(60～ 120 ml),平均手术时间160 min(125 ～ 180 min),平均肾段动脉阻断时间25 min(15 ～26 min),术后肌酐值平均为81.4μmol/L(71～ 155 μmol/L).术后病理示肾透明细胞癌23例,嫌色细胞癌1例.术后随访6 ～36个月,1例术后肌酐一过性升高,余无出血、感染、肾周脏器损伤、胸膜损伤、肺栓塞、肾功能衰竭、肝功能衰竭、漏尿等并发症,无肿瘤局部复发及远处转移.结论 选择性肾段动脉阻断的肾部分切除术治疗早期肾癌安全有效,对肾脏创伤小,可以尽可能多地保留肾脏功能.

abstractsObjective To investigate the nephron-sparing surgery of selective blockage to renal segmentary artery.Methods The clinical data of 24 patients with T1 renal tumor underwent the nephron-sparing surgery of selective blockage to renal segmentary artery from January 2008 to January 2012were retrospectively analyzed.Two cases were tumors of solitarykidney,6 cases were disordered or with potentially impaired function at contralateral kidney,16 cases were with normal contralateral kidney.The tumor was lacated at superiorsegment in 8 cases,inferior segment in 7 cases,superior anterior segment in 2 cases,inferior anterior segment in 2 cases,posterior segment in 2 cases,superior segment and superior anterior segment in 3 cases.Twenty cases were exophytic and 4 cases endogenous.The diameter of tumors masses were from 2.2 cm to 6.8 cm,average diameter 4.2 cm.The average preoperative serum creatinine was 80 μmol/L(67-110 μmol/L).Results All operations were completed successfully.The average blood loss was 80 ml(60-120 ml),the average operative duration was 160 min(125-180 min),the average blockage duration of renal segmental artery was 25 min(15-26 min).The average postoperative serum creatinine was 81.4 μmol/L(71-155 μmol/L).Postoperative pathology:23 cases were renal clear cell carcinoma,1 case was chromophobe renal cell carcinoma.All cases were followed up from 6 to 36 months.The follow-up indicated there were no complications,such as bleeding,infection,perirenal visceral injury,pleural damage,pulmonary embolism,renal failure and liver failure and leakage,no tumor local recurrence and distant metastasis.However,there was temporary increases in serum creatinine in 1 case after operation.Conclusions The nephron-sparing surgery of selective blockage to renal segmentary artery is safe and effective,which can maximally preserve the unaffected renal parenchyma.