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目的:报告泌尿外科4年内后腹腔镜下肾肿瘤剜除的97例患者肾动脉阻断时间与术后肾功能受损情况。方法:回顾分析2011年7月~2015年3月后腹腔镜肾肿瘤剜除患者97例,肾动脉全阻断在17~25min组(A组)36例,男20例,女16例,年龄(52.3±7.8)岁,肿瘤直径(2.9±0.5)cm;肾动脉全阻断在26~30min组(B组)42例,男23例,女19例,年龄(51.3±8.9)岁,肿瘤直径(2.8±0.6)cm;肾动脉全阻断在31~45min组(C组)19例,男10例,女9例,年龄(53.4±7.2)岁,肿瘤直径(3.0±0.7)cm。结果:改良R.E.N.A.L.评分A组(8.6±0.6)分;B组(8.2±0.5)分;C组(9.2±0.6)分,R.E.N.A.L.评分组间比较差异有统计学意义,进行组间两两比较时,A组和B组之间比较差异无统计学意义,C组和A组、B组之间均差异有统计学意义;A组术前GFR(43.2±6.2)ml/min,术后3个月GFR(36.7±5.0)ml/min,B组术前GRF(45.3±4.7)ml/min,术后3个月GRF(38.3±4.7)ml/min;C组术前GRF(44.6±4.8)ml/min,术后3个月GFR(31.5±5.6)ml/min。术前各组之间差异无统计学意义,术后A组和B组之间比较差异无统计学意义,C组和A组、B组之间差异有统计学意义(P值分别为:0.000和0.000)。结论:术前改良R.E.N.A.L.评分与后腹腔镜下肾动脉阻断时间相关,热缺血时间控制在30min内的肾动脉全阻断肾肿瘤剜除术后肾功能损伤较小。
OBJECTIVE: To report the renal artery occlusion time and postoperative renal impairment in 97 patients with laparoscopic renal tumor removal within 4 years after urology. Methods: Ninety-seven patients with laparoscopic nephroureterectomy were retrospectively analyzed. Thirty-six patients (20 males and 16 females) were randomly divided into group A (n = 17) (52.3 ± 7.8) years old, tumor diameter (2.9 ± 0.5) cm; renal artery occlusion in the 26 ~ 30min group (group B) 42 patients, 23 males and 19 females, age (51.3 ± 8.9) The diameter of the renal artery was (2.8 ± 0.6) cm. There were 19 cases of renal artery occlusion in the group of 31-45 minutes (group C). There were 10 males and 9 females. The mean age was 53.4 ± 7.2 years. The diameter of tumor was 3.0 ± 0.7 cm. Results: The modified RENAL score was significantly higher in group A than in group A (8.6 ± 0.6), group B (8.2 ± 0.5), group C (9.2 ± 0.6), and group RENAL , There was no significant difference between group A and group B, there was significant difference between group C and group A and group B. GFR (43.2 ± 6.2) ml / min, group A (36.7 ± 5.0) ml / min, GRF (45.3 ± 4.7) ml / min in group B and GRF (38.3 ± 4.7) ml / ml / min, GFR (31.5 ± 5.6) ml / min at 3 months after operation. There was no significant difference between preoperative groups, there was no significant difference between A group and B group after operation, there was significant difference between C group and A group and B group (P = 0.000 And 0.000). CONCLUSION: The preoperative improvement of R.E.N.A.L. score correlates with the duration of retroperitoneal laparoscopic renal artery occlusion. Renal arterial total occlusion of renal tumor within 30 min of warm ischemia is associated with less renal damage.