腹腔镜"蘑菇状"剜除术治疗外生性肾血管平滑肌脂肪瘤的临床应用

目的对比研究腹腔镜下外生性肾血管平滑肌脂肪瘤"蘑菇状"剜除与标准肾部分切除术的安全性及有效性,为肾血管平滑肌脂肪瘤腹腔镜下"蘑菇状"剜除术术式的建立提供临床依据。 方法选取海南医学院第二附属医院与解放军总医院2018年1月至2019年5月期间,接受腹腔镜手术的肾血管平滑肌脂肪瘤患者53例,其中25例沿肿瘤假包膜行"蘑菇状"剜除术(A组)、28例行肾部分切除术(B组)。比较两组手术患者的肾动脉阻断时间、手术时间、术中出血量、术后24 h血红蛋白、术后eGFR(estimated glomerular filtration rate,估计肾小球率过滤)的变化、术后住院时间和术后肿瘤复发率。 结果53例手术无术中转开放,无死亡病例。肾动脉阻断时间：A组(11.9±2.2)min、B组(21.5±6.5) min(P<0.001)。手术时间：A组(87.9±24.8)min、B组(114.3±38.9) min(P<0.001)。术中出血量：A组20 ml(20～40)ml、B组50 ml(50～100)ml(P<0.001)。术后24 h血红蛋白变化：A组(7.4±4.3) g/L、B组(12.4±8.8) g/L(P＝0.013)。术后24 h eGFR变化：A组(6.2±7.2 )ml(min·1.73 m²),B组(12.7±12.8)ml(min·1.73 m²)(P＝0.027)。术后6个月eGFR变化：A组(1.5±3.7)ml(min·1.73 m²)、B组(6.5±5.6)ml(min·1.73 m²)(P<0.001)。术后住院时间：A组4.0 d(3～4)d、B组4.5 d(3～6)d(P＝0.023)。术后随访两组术后肿瘤均无复发。 结论采用腹腔镜"蘑菇状"剜除术治疗外生性肾血管平滑肌脂肪瘤在肾动脉阻断时间、术中出血量、术后24 h血红蛋白、术后eGFR变化、术后住院时间等方面均优于传统肾部分切除术,两组术后肿瘤均无复发;该方法安全、有效,适于临床推广。

Clinical application of laparoscopic mushroom shaped enucleation in the treatment of ectopic renal angiomyolipoma

ObjectiveTo compare the safety and efficacy of laparoscopic "mushroom" enucleation and standard partial nephrectomy for ectopic renal angiomyolipoma, so as to provide clinical basis for the establishment of laparoscopic "mushroom" enucleation of renal angiomyolipoma. MethodsFrom Jan.2018 to May 2019, 53 patients with renal angiomyolipoma underwent laparoscopic surgery in the Second Affiliated Hospital of Hainan Medical College and the Chinese PLA General Hospital. Among them, 25 cases underwent mushroom shaped enucleation along the pseudocapsule of the tumor (group A), 28 cases underwent partial nephrectomy (group B). The changes of renal artery occlusion time, operation time, intraoperative blood loss, preoperative and postoperative hemoglobin and eGFR (estimated glomerular filtration rate) were compared between the two groups. Results53 cases of operation were not converted to open, no death cases. renal artery occlusion time: (11.9 ± 2.2)min in group A. (21.5 ± 6.5)min in group B(P< 0.001). Operation time: ( 87.9 ± 24.8) min in group A. (114.3 ± 38.9) min in group B(P< 0.001). Intraoperative blood loss: group A: 20 ml(20-40)ml. group B: 50 ml(50-100)ml(P< 0.001). The change of hemoglobin 24 hours after operation: group A: (7.4±4.3)g/L. group B: (12.4±8.8)g/L(P=0.013). 24 hours after operation, the change of eGFR was (6.2 ± 7.2) ml (min·1.73 m²) in group A, (12.7 ± 12.8) ml (min·1.73 m²) in group B(P= 0.027). The change of eGFR in group A was (1.5 ± 3.7)ml(min·1.73 m²), and in group B was( 6.5 ± 5.6) ml(min·1.73 m²)(P< 0.001). Postoperative hospitalization days, group A: 4.0(3-4)days; group B: 4.5(3-6)days(P= 0.023). Postoperative follow-up: there was no recurrence in both groups. ConclusionsLaparoscopic "mushroom" enucleation for ectopic renal angiomyolipoma was superior to traditional partial nephrectomy in terms of renal artery occlusion time, intraoperative blood loss, changes of hemoglobin and eGFR, and length of hospital stay. There was no recurrence of tumor in both groups. This method is safe and effective and suitable for clinical application.