本文選題：早期腎癌　切入點(diǎn)：保留腎單位手術(shù)　出處：《鄭州大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 通過(guò)對(duì)比研究不阻斷腎動(dòng)脈保留腎單位手術(shù)與傳統(tǒng)阻斷腎動(dòng)脈保留腎單位手術(shù)治療局限性腎癌的臨床指標(biāo)，評(píng)估不阻斷腎動(dòng)脈保留腎單位手術(shù)的療效及安全性。 方法 回顧性分析鄭州大學(xué)附屬腫瘤醫(yī)院在2012年4月-2013年12月期間的84例行保留腎單位手術(shù)治療的小腎癌患者，其中41例患者行不阻斷腎動(dòng)脈保留腎單位手術(shù)（觀察組），43例行傳統(tǒng)阻斷腎動(dòng)脈保留腎單位手術(shù)（對(duì)照組）。對(duì)兩組患者腫瘤大小、手術(shù)時(shí)間、術(shù)中出血量、切緣陰性率；術(shù)后第1天引流量、術(shù)后住院時(shí)間、相關(guān)并發(fā)癥；術(shù)前和術(shù)后1周、6月肌酐水平變化；術(shù)前、術(shù)后3月和術(shù)后6月患側(cè)腎GFR變化等指標(biāo)進(jìn)行回顧性分析。通過(guò)病案查詢、術(shù)后隨訪等方式獲得相關(guān)臨床資料，進(jìn)行對(duì)比研究，評(píng)估不阻斷腎動(dòng)脈保留腎單位手術(shù)治療局限性腎癌的療效及安全性。 結(jié)果 84例患者均成功行保留腎單位手術(shù)。不阻斷腎動(dòng)脈組與阻斷腎動(dòng)脈組的平均腫瘤大小分別為2.8±0.7cm和3.0±0.6cm，無(wú)明顯統(tǒng)計(jì)學(xué)差異（P＞0.05）；手術(shù)時(shí)間分別為141.5±29.6min和132.7±30.1min，無(wú)明顯統(tǒng)計(jì)學(xué)差異（P＞0.05）；術(shù)中出血量分別為289.5±86.5ml和97.5±33.5ml，存在顯著統(tǒng)計(jì)學(xué)差異（P＜0.05）；術(shù)后第1天引流量分別為197.75±13.6ml和201.3±12.2ml，無(wú)明顯統(tǒng)計(jì)學(xué)差異（P＞0.05）；術(shù)后住院時(shí)間分別為9.0±0.8d和9.1±0.9d，無(wú)明顯統(tǒng)計(jì)學(xué)差異（P＞0.05）；阻斷腎動(dòng)脈組平均阻斷時(shí)間為21.23±3.89min，術(shù)前肌酐水平分別為65.40±11.90μmol/L和64.24±8.64μmol/L，無(wú)明顯統(tǒng)計(jì)學(xué)差異（P＞0.05）；術(shù)后1周肌酐水平較術(shù)前差值分別為88.40±8.47μmol/L和105.43±9.33μmol/L，存在顯著統(tǒng)計(jì)學(xué)差異（P＜0.05）；術(shù)后6月肌酐水平較術(shù)前差值分別為67.35±9.69μmol/L和65.48±7.31μmol/L，無(wú)明顯統(tǒng)計(jì)學(xué)差異（P＞0.05）；術(shù)前患腎GFR分別為52.61±6.22ml/min和51.29±3.99ml/min，無(wú)明顯統(tǒng)計(jì)學(xué)差異（P＞0.05）；術(shù)后3月患腎GFR分別為46.59±6.19ml/min和35.45±3.77ml/min，存在明顯統(tǒng)計(jì)學(xué)差異（P＜0.05），術(shù)后6月患腎GFR分別為48.42±6.07ml/min和37.72±3.67ml/min，存在明顯統(tǒng)計(jì)學(xué)差異（P＜0.05）。術(shù)后病理示兩組患者切緣均為陰性。兩組患者在隨訪期間均未發(fā)生腫瘤復(fù)發(fā)及轉(zhuǎn)移。阻斷腎動(dòng)脈手術(shù)組1例患者發(fā)生術(shù)后切口感染，對(duì)癥處理后痊愈，，兩組均無(wú)死亡病例。 結(jié)論 不阻斷腎動(dòng)脈保留腎單位手術(shù)是一種可推廣的手術(shù)方式，但需要選擇合適的病材。
[Abstract]:Purpose. To evaluate the efficacy and safety of renal artery sparing surgery without blocking renal artery in the treatment of local renal cell carcinoma, the clinical indexes of renal unit sparing surgery without renal artery occlusion and traditional renal artery sparing unit surgery were compared. Method. A retrospective analysis was made on 84 patients with small renal cell carcinoma treated by nephron-sparing surgery from April 2012 to December 2013 in the affiliated Cancer Hospital of Zhengzhou University. Among them, 41 cases underwent renal unit sparing operation without renal artery occlusion (observation group 43 cases received traditional renal artery preservation surgery (control group). For the two groups, tumor size, operation time, intraoperative bleeding volume, margin negative rate; On the first day after operation, drainage, hospital stay, related complications, creatinine level before and after 1 week, June, preoperative, postoperative March and June after operation were analyzed retrospectively. To evaluate the efficacy and safety of renal unit sparing surgery without blocking renal artery in the treatment of local renal cell carcinoma. Results. The mean tumor size was 2.8 鹵0.7cm and 3.0 鹵0.6cm in the unblocked renal artery group and 3.0 鹵0.6 cm in the renal artery occlusion group, respectively (P > 0.05), and the operative time was 141.5 鹵29.6min and 132.7 鹵30.1min, respectively. The volume of intraoperative bleeding was 289.5 鹵86.5 ml and 97.5 鹵33.5 ml, respectively (P < 0.05), the drainage volume was 197.75 鹵13.6ml and 201.3 鹵12.2ml on the first day after operation, there was no significant difference (P > 0.05), and the hospitalization time was 9.0 鹵0.8d and 9.1 鹵0.9d, respectively (P > 0.05). The mean occlusion time was 21.23 鹵3.89 minutes, the preoperative creatinine levels were 65.40 鹵11.90 渭 mol/L and 64.24 鹵8.64 渭 mol / L, respectively (P > 0.05), and the creatinine levels were 88.40 鹵8.47 渭 mol/L and 105.43 鹵9.33 渭 mol / L respectively at 1 week after operation (P < 0.05). The anterior difference was 67.35 鹵9.69 渭 mol/L and 65.48 鹵7.31 渭 mol / L, respectively (P > 0.05), and the preoperative GFR was 52.61 鹵6.22 ml / min and 51.29 鹵3.99 ml / min, respectively (P > 0.05). On March, the renal GFR was 46.59 鹵6.19 ml / min and 35.45 鹵3.77 ml / min, respectively (P < 0.05). For 48.42 鹵6.07ml / min and 37.72 鹵3.67ml / min, there was significant difference (P < 0.05). Postoperative pathology showed that the margin of resection was negative in both groups. No tumor recurrence or metastasis occurred in the two groups during the follow-up period. One patient in the renal artery occlusion group developed postoperative incision infection. There were no death cases in both groups. Conclusion. Renal artery-sparing surgery without blocking renal artery is a popularized procedure, but it is necessary to select suitable materials.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.11

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