肾周脂肪粘连对后腹腔镜肾部分切除术的影响*

Impact of aderent perirenal fat on retroperitoneal laparoscopic partial nephrectomy*

摘要:

目的??评估肾周脂肪粘连对后腹腔镜肾部分切除术（PN）的影响。方法?回顾2013年10月－2015年12月收治行后腹腔镜PN术的患者共52例。通过术前CT图像和手术操作，依据患者肾周脂肪有无粘连，分成粘连组与无粘连组。比较两组患者的一般临床资料及围手术期数据之间的差异。结果?粘连组与无粘连组在体质指数（BMI）、肿瘤最大径、肾脏热缺血时间、住院时间、美国麻醉师协会评分（ASA）及RENAL评分的比较差异无统计学意义（P >0.05）。粘连组与无粘连组相比年龄大[（59.25±11.03）vs（49.71±11.86）岁，P =0.004]，男性患者比例高（75.0% vs 46.4%，P =0.036），高血压患者多（62.5% vs 28.6%，P =0.014），糖尿病患者多（41.7% vs 14.3%，P =0.026），腹腔内脂肪（IAF）多[（2.02±0.47）vs（1.35±0.66）cm，P =0.000]，手术时间长[（146.08±45.45）vs（119.32±28.83）min，P =0.017）]，术中失血量多[（82.92±45.73）vs（51.79±25.10）ml，P =0.005）]。结论?肾周脂肪粘连使后腹腔镜PN术的手术时间及出血量增加，但对肾脏热缺血时间及住院时间无明显影响。这在一定程度上增加了手术过程中分离的难度，但并不增加肿瘤切除的难度。

Abstract:

Objective?To evaluate the impact of aderent perirenal fat (APF) on retroperitoneal laparoscopic partial nephrectomy (RLPN).?Methods?Clinical data of 52 patients who underwent RLPN for a small renal tumor from October 2013 to December 2015 was analyzed retrospectively. All the patients were divided into two groups according to the presence of APF by preoperative computed tomography imaging. Clinical data was collected including patients’ age, gender, BMI, history of hypertension, history of diabetes, American Society of Anesthesiologists score (ASA), intra-abdominal fat (IAF), tumor size, RENAL Nephrometry score (RNS), operative time, warm ischaemia time (WIT), estimated blood loss (EBL), and length of hospital stay.?Results?Between the two groups, the BMI, tumor size, WIT, length of hospital stay were similar [(26.70 ± 3.33) kg/m2 vs (25.65 ± 4.01) kg/m2, (3.53 ± 1.21) cm vs (3.64 ± 1.05) cm, (27.17 ± 7.55) min vs (25.21 ± 5.64) min, (12.54 ± 4.06) d vs (10.61 ± 3.70) d, P > 0.05)], as well as the ASA and RNS. APF patients were older [(59.25 ± 11.03) y vs (49.71 ± 11.86) y, P = 0.004]. There were a high proportion of men (75.0% vs 46.4%, P = 0.036), patients with hypertension (62.5% vs 28.6%, P = 0.014), and patients with diabetes (41.7% vs 14.3%, P = 0.026). In the APF group, IAF was more [(2.02 ± 0.47) cm vs (1.35 ± 0.66) cm, P = 0.000], operative time was longer [(146.08 ± 45.45) min vs (119.32 ± 28.83) min, P = 0.017], and EBL was higher [(82.92 ± 45.73) ml vs (51.79 ± 25.10) ml, P = 0.005].?Conclusion?The adherent preirenal fat sticking renal results in a longer operative time and a higher EBL, but has no influences on the WIT and length of hospital stay. APF makes it difficult to expose the tumor, not to remove it.