低温阻断肾血流在保留肾单位手术中的应用-外科学专业论文.docx

— — PAGE 1— 摘 要 低温阻断肾血流在保留肾单位手术中的应用 研究生：郭 驹 导师：王玉杰 副教授 摘 要 目的: 探讨低温阻断肾血流行保留肾单位手术治疗肾肿瘤的疗效。方法: 回顾性 分析 35 例行保留肾单位患者的临床资料。男性 24 例，女性 11 例，年龄 25～70 岁， 平均 50.2 岁。均经超声、CT 或 MRI 检查明确肿瘤大小、部位，采用低温阻断肾血 流技术，阻断前静点肌酐，开放肾血流后静点甘露醇或速尿，据肿瘤切缘 0.5～1.0cm 切除肿瘤或肿瘤剜除术。手术前后行肾核素扫描（ECT）检测分肾功能。结果: 本组 35 例肾血流阻断时间 17～90min,平均 29.6min。术中出血量少,无输血病例。术后 3 天复查血 Cr、BUN，除 1 例孤立肾外肌酐轻度上升 4 天后降至正常，余均属正常范 围。3 例术后一周出现大量血尿，其中 2 例行右肾动脉栓塞术，1 例行左肾切除术。 31 例术后 1 月行 CT 检查,显示术侧肾脏显影良好，术区无血肿，术后 3 月行 ECT， 术侧肾脏肾小球滤过率较术前无明显变化（P0.05）。术后 34 例获随访,随访时间 2～ 18 个月，平均随访 13 个月，未见复发及转移，未见需行血透治疗。结论：保留肾单 位手术中，综合采用低温阻断肾血流、静电肌酐和速尿能有效保护肾脏功能，还可 使术野清晰，减少手术并发症的发生。 关键词：保留肾单位手术；肾肿瘤；低温 新疆医科大学医学硕士学位论文 Nephron sparing surgery with renal cold ischemia Postgraduate student: GuoJu Tutor: WangYuJi Abstract Objective: To evaluate the clinical efficacy of nephron sparing surgery with renal cold ischemia for thetreatment of renal tumors. Methods: We retrospectively reviewed the clinical records of 35 cases of patients who underwent Nephron sparing surgery with renal cold ischemia. Thirty five patients(24 mailes and 11 femailes). The mean age was 50.2 years old, from 25-70 years old. They were diagnosed with renal tumors by Ultrasound, CT or MRI. All the pataent’s renal hilar were blocked, before that gave the patients inosine 1.0g and after that gave mannitol or furosemide.tumor masses where resected with the surgical margin of 0.5-1.0cm or were enucleared. Renal function was examined by ECT before and after surgery. Results: 35 cases of this group of the mean renal pedicle blocking time was 29.6min , no blood transfusion cases. Reviewed after three days of blood Cr, BUN, all were normal range except one with solitary kidney .there was no case with local hematoma in the srgical site conformied by CT.3 months after surgery,renal scan date did not reveal any significant decrease in GFR in the operated kidney. After 31 cases were followed up for 2 ~ 18 months, with an average follow-up of 13 months, no recurrence or metastasis, no need to line hemodial