1 470 nm激光在肾部分切除术中的应用研究

doi:10.3760/cma.j.issn.1007-1245.2023.15.025

国际医药卫生导报 ›› 2023, Vol. 29 ›› Issue (15): 2177-2180.DOI: 10.3760/cma.j.issn.1007-1245.2023.15.025

1 470 nm激光在肾部分切除术中的应用研究

于世超何惠斌于晶

东莞康华医院泌尿外科，东莞　523000

收稿日期:2023-03-09 出版日期:2023-08-01 发布日期:2023-08-28
通讯作者: 何惠斌，Email：53266706@qq.com
基金资助:
2020年东莞市社会科技发展（一般）项目（202050715059677）

Application of 1 470 nm laser in partial nephrectomy

Yu Shichao, He Huibin, Yu Jing

Department of Urology, Dongguan Kanghua Hospital, Dongguan 523000, China

Received:2023-03-09 Online:2023-08-01 Published:2023-08-28
Contact: He Huibin, Email: 53266706@qq.com
Supported by:
Dongguan Social Science and Technology Development (General)Project in 2020 (202050715059677)

摘要/Abstract

摘要：

目的　比较1 470 nm激光肾部分切除术与保留肾单位手术（NSS）治疗肾透明细胞癌的疗效。方法　回顾性分析2020年4月至2022年12月东莞康华医院收治的32例肾透明细胞癌患者的临床资料，根据手术方式的不同分为激光组和NSS组，每组16例。NSS组中男10例、女6例，年龄（58.63±8.34）岁，采用NSS治疗；激光组中男9例、女7例，年龄（58.06±9.18）岁，采用1 470 nm激光肾部分切除术。比较两组手术时间、术后住院时间、引流管拔除时间、术中出血量及手术前后肌酐变化、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）水平。采用Fisher确切概率法、独立样本t检验、Mann Whitney U检验。结果　两组患者手术时间比较差异无统计学意义（t=0.124、P>0.05）。两组患者的术后住院时间（Z=4.786，P<0.001）、引流管拔除时间（Z=4.824，P<0.001）、术中出血量（Z=4.768，P<0.001）、手术前后肌酐差值（1周、3个月）（t=12.134、4.768，均P<0.001）比较差异均有统计学意义。两组术前NGAL水平比较差异无统计学意义（P>0.05）。激光组NGAL水平术后2 h［（59.63±6.35）μg/L比（161.31±5.53）μg/L］、术后4 h［（54.94±5.24）μg/L比（181.63±6.87）μg/L］、术后24 h［（48.69±5.67）μg/L比（130.00±4.40）μg/L］均低于NSS组（t=46.756、56.782、43.898，均P<0.001）。结论　1 470 nm激光肾部分切除术切实可行，能有效保留患者肾脏功能，缩短住院天数及拔管时间。

关键词:

肾透明细胞癌, 肾部分切除术, 1 470 nm激光, 肾功能

Abstract:

Objective　To compare the efficacies of 1 470 nm laser partial nephrectomy and nephron sparing surgery (NSS) in the treatment of renal clear cell carcinoma. Methods　The clinical data of 32 patients with renal clear cell carcinoma admitted to Dongguan Kanghua Hospital from April 2020 to December 2022 were retrospectively analyzed and were divided into a laser group (16 cases) and a NSS group (16 cases) according to different surgical methods. In the NSS group, 10 males and 6 females, aged (58.63±8.34) years, were treated with NSS. In the laser group, 9 males and 7 females, aged (58.06±9.18) years, were treated with 1 470 nm laser partial nephrectomy. The operation time, length of postoperative hospital stay, drainage tube removal time, intraoperative blood loss, creatinine changes before and after surgery, and neutrophil gelatinase-associated lipid carrier protein (NGAL) levels before and after surgery were compared between the two groups. Fisher exact probability method, independent sample t test, and Mann Whitney U test were used for statistical analysis. Results　There was no statistically significant difference in the operation time between the two groups (t=0.124, P>0.05). There were statistically significant differences in the length of postoperative hospital stay (Z=4.786, P<0.001), drainage tube removal time (Z=4.824, P<0.001), intraoperative blood loss (Z=4.768, P<0.001), and creatinine differences before and after surgery (1 week and 3 months) between the two groups (t=12.134 and 4.768, both P<0.001). There was no statistically significant difference in the preoperative NGAL level between the two groups (P>0.05). The NGAL levels in the laser group 2, 4, and 24 h after surgery were lower than those in the NSS group [(59.63±6.35) μg/L vs. (161.31±5.53) μg/L, (54.94±5.24) μg/L vs. (181.63±6.88) μg/L, (48.69±5.67) μg/L vs. (130.00±4.40) μg/L] (t=46.756, 56.782, and 43.898; all P<0.001). Conclusion　1 470 nm laser partial nephrectomy is feasible, and can effectively preserve the kidney function and shorten the hospital stay and extubation time.

Key words:

Clear cell carcinoma of kidney, Partial nephrectomy, 1 470 nm laser, Renal function

于世超何惠斌于晶.

1 470 nm激光在肾部分切除术中的应用研究 [J]. 国际医药卫生导报, 2023, 29(15): 2177-2180.

Yu Shichao, He Huibin, Yu Jing.

Application of 1 470 nm laser in partial nephrectomy [J]. International Medicine and Health Guidance News, 2023, 29(15): 2177-2180.

参考文献

[1] Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6): 394-424. DOI: 10.3322/caac.21492.
[2] Jonasch E, Gao J, Rathmell WK. Renal cell carcinoma[J]. BMJ, 2014, 349: g4797. DOI: 10.1136/bmj.g4797.
[3] MacLennan S, Imamura M, Lapitan MC, et al. Systematic review of oncological outcomes following surgical management of localised renal cancer[J]. Eur Urol, 2012, 61(5): 972-993. DOI: 10.1016/j.eururo.2012.02.039.
[4] Thompson RH, Lane BR, Lohse CM, et al. Every minute counts when the renal hilum is clamped during partial nephrectomy[J]. Eur Urol, 2010, 58(3): 340-345. DOI: 10.1016/j.eururo.2010.05.047.
[5] Lotan Y, Gettman MT, Ogan K, et al. Clinical use of the holmium: YAG laser in laparoscopic partial nephrectomy[J]. J Endourol, 2002, 16(5): 289-292. DOI: 10.1089/089277902760102767.
[6] Kyriazis I, Ozsoy M, Kallidonis P, et al. Current evidence on lasers in laparoscopy: partial nephrectomy[J]. World J Urol, 2015, 33(4): 589-594. DOI: 10.1007/s00345-014- 1343-0.
[7] Sciarra A, Von Heland M, Minisola F, et al. Thulium laser supported nephron sparing surgery for renal cell carcinoma[J]. J Urol, 2013, 190(2): 698-701. DOI: 10.1016/j.juro.2013.01.079.
[8] Loertzer H, Strauß A, Ringert RH, et al. Laser-supported partial laparoscopic nephrectomy for renal cell carcinoma without ischaemia time[J]. BMC Urol, 2013, 13: 31. DOI: 10.1186/1471-2490-13-31.
[9] Drerup M, Magdy A, Hager M, et al. Non-ischemic laparoscopic partial nephrectomy using 1318-nm diode laser for small exophytic renal tumors[J]. BMC Urol, 2018, 18(1): 99. DOI: 10.1186/s12894-018-0405-9.
[10] Knezevic N, Kulis T, Maric M, et al. Laparoscopic partial nephrectomy with diode laser: a promising technique[J]. Photomed Laser Surg, 2014, 32(2): 101-105. DOI: 10.1089/pho.2013.3646.
[11] 王杭,朱延军,姜帅,等. 双波长激光腹腔镜下不阻断肾动脉保留肾单位手术的疗效[J]. 中华泌尿外科杂志,2017,38(7):511-514. DOI:10.3760/cma.j.issn.1000-6702.2017. 07.008.
[12] Yunanto A, Wahyudi I, Hamid ARAH, et al. Zero ischaemia open partial nephrectomy using Thulium laser in pediatric renal tumor: a first experience[J]. Urol Case Rep, 2018, 19: 45-47. DOI: 10.1016/j.eucr.2018.04.006.
[13] Khoder WY, Sroka R, Siegert S, et al. Outcome of laser-assisted laparoscopic partial nephrectomy without ischaemia for peripheral renal tumours[J]. World J Urol, 2012, 30(5): 633-638. DOI: 10.1007/s00345-011-0807-8.
[14] Wang Y, Shao J, Lü Y, et al. Thulium laser-assisted versus conventional laparoscopic partial nephrectomy for the small renal mass[J]. Lasers Surg Med, 2020, 52(5): 402-407. DOI: 10.1002/lsm.23153.
[15] 王启飞,车翔宇,姜涛,等. 腹腔镜下零缺血免缝合钬激光肾部分切除术的临床应用价值[J]. 医学与哲学,2017,38(22):41-44. DOI:10.12014/j.issn.1002-0772.2017.11b.14.
[16] 徐维锋,纪志刚,刘广华,等. 后腹腔镜下双波长激光辅助零缺血肾部分切除术16例报告[J]. 临床泌尿外科杂志,2019,34(1):6-8,13. DOI:10.13201/j.issn.1001-1420.2019. 01.002.
[17] 王宇伟,何华东,张文豪,等. 980nm半导体红激光辅助后腹腔镜下"零缺血"肾部分切除术的应用经验[J]. 临床泌尿外科杂志,2022,37(1):37-41. DOI:10.13201/j.issn.1001- 1420.2022.01.009.
[18] Marakala V. Neutrophil gelatinase-associated lipocalin (NGAL) in kidney injury - a systematic review[J]. Clin Chim Acta, 2022, 536: 135-141. DOI: 10.1016/j.cca.2022.08.029.
[19] Kjeldsen L, Johnsen AH, Sengeløv H, et al. Isolation and primary structure of NGAL, a novel protein associated with human neutrophil gelatinase[J]. J Biol Chem, 1993, 268(14): 10425-10432.
[20] Bundgaard JR, Sengeløv H, Borregaard N, et al. Molecular cloning and expression of a cDNA encoding NGAL: a lipocalin expressed in human neutrophils[J]. Biochem Biophys Res Commun, 1994, 202(3): 1468-1475. DOI: 10.1006/bbrc.1994.2096.

1 470 nm激光在肾部分切除术中的应用研究

Application of 1 470 nm laser in partial nephrectomy

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