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

【摘要】：目的 通過對比研究不阻斷腎動脈保留腎單位手術與傳統(tǒng)阻斷腎動脈保留腎單位手術治療局限性腎癌的臨床指標，評估不阻斷腎動脈保留腎單位手術的療效及安全性。 方法 回顧性分析鄭州大學附屬腫瘤醫(yī)院在2012年4月-2013年12月期間的84例行保留腎單位手術治療的小腎癌患者，其中41例患者行不阻斷腎動脈保留腎單位手術（觀察組），43例行傳統(tǒng)阻斷腎動脈保留腎單位手術（對照組）。對兩組患者腫瘤大小、手術時間、術中出血量、切緣陰性率；術后第1天引流量、術后住院時間、相關并發(fā)癥；術前和術后1周、6月肌酐水平變化；術前、術后3月和術后6月患側腎GFR變化等指標進行回顧性分析。通過病案查詢、術后隨訪等方式獲得相關臨床資料，進行對比研究，評估不阻斷腎動脈保留腎單位手術治療局限性腎癌的療效及安全性。 結果 84例患者均成功行保留腎單位手術。不阻斷腎動脈組與阻斷腎動脈組的平均腫瘤大小分別為2.8±0.7cm和3.0±0.6cm，無明顯統(tǒng)計學差異（P＞0.05）；手術時間分別為141.5±29.6min和132.7±30.1min，無明顯統(tǒng)計學差異（P＞0.05）；術中出血量分別為289.5±86.5ml和97.5±33.5ml，存在顯著統(tǒng)計學差異（P＜0.05）；術后第1天引流量分別為197.75±13.6ml和201.3±12.2ml，無明顯統(tǒng)計學差異（P＞0.05）；術后住院時間分別為9.0±0.8d和9.1±0.9d，無明顯統(tǒng)計學差異（P＞0.05）；阻斷腎動脈組平均阻斷時間為21.23±3.89min，術前肌酐水平分別為65.40±11.90μmol/L和64.24±8.64μmol/L，無明顯統(tǒng)計學差異（P＞0.05）；術后1周肌酐水平較術前差值分別為88.40±8.47μmol/L和105.43±9.33μmol/L，存在顯著統(tǒng)計學差異（P＜0.05）；術后6月肌酐水平較術前差值分別為67.35±9.69μmol/L和65.48±7.31μmol/L，無明顯統(tǒng)計學差異（P＞0.05）；術前患腎GFR分別為52.61±6.22ml/min和51.29±3.99ml/min，無明顯統(tǒng)計學差異（P＞0.05）；術后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)計學差異（P＜0.05），術后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)計學差異（P＜0.05）。術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)生腫瘤復發(fā)及轉移。阻斷腎動脈手術組1例患者發(fā)生術后切口感染，對癥處理后痊愈，，兩組均無死亡病例。 結論 不阻斷腎動脈保留腎單位手術是一種可推廣的手術方式，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.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.11

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