热缺血可以导致传统腹腔镜肾部分切除手术（LPN）的肾功能损害。本研究，上海仁济医院肾脏肿瘤亚专业团队比较了零缺血腹腔镜射频消融辅助肿瘤剜除手术（LRATE）与传统腹腔镜肾部分切除手术治疗cT1a期肾肿瘤的肾功能保护、围手术期并发症及临床疗效。

　　方法 2013年4月至2015年3月，仁济医院泌尿科进行了一项针对预期进行腹腔镜保留肾单位手术的cT1a期肾脏肿瘤患者的前瞻性随机对照临床研究（除外肿瘤累及集合管系统）。LRATE组在进行肿瘤射频消融后进行无阻断的肿瘤剜除手术，LPN组则进行传统腹腔镜肾脏部分切手术。首要终点指标为2组患者的术后12月核素肾图显示的患侧肾功能变化。次要终点指标是围手术期指标以及术后局部疗效等。

　　结果  本研究最终入组病例89例，其中LRATE组44例，LPN组45例。与LPN组比较，DTPA核素肾图显示LRATE组患者术后3个月（10.2% vs. 20.5%，P= 0.001）和12个月（7.6% vs 16.2%，P=0.002）手术侧患肾GFR下降比例显著降低。LRATE组患者中位手术时间更短（P=0.002），中位术中出血量较少（P＜0.001），中位住院时间较短（P=0.029），而术后并发症发生率相当（P=1.000）。本研究中所有入组患者均无病理切缘阳性病例及局部复发病例。

　　结论  零缺血腹腔镜射频消融辅助肿瘤剜除手术是一种新型安全有效的微创保留肾单位手术。相比传统腹腔镜肾脏部分切除手术，LRATE既可以完整切除肿瘤，又具有肾功能保护效果好，出血量少，恢复快，手术时间短等优势。对于部分合适选择的病例，LRATE是一种良好的可供选择的微创保肾手术方式。

　　黄吉炜 博士

　　博士，主治医师，目前在黄翼然教授领衔的上海仁济医院泌尿科肾脏肿瘤亚专业团队工作。2014年2月至2015年2月公派赴美国哈佛大学医学院附属麻省总医院泌尿外科进修学习泌尿系肿瘤的诊治和进行肾脏肿瘤博士后研究工作。擅长各种泌尿科肾脏肿瘤，肾上腺肿瘤，上尿路尿路上皮癌的微创手术。承担国家自然基金青年项目课题一项。以第一作者在Journal of Urology，British Journal of Urology等泌尿科顶级杂志发表论文10余篇。

研究摘要

1091: Comparing zero ischemia laparoscopic radiofrequency ablation assisted tumor enucleation and laparoscopic partial nephrectomy for clinical T1a renal tumor: A randomized clinical trial Introduction & Objectives

Warm ischemia leads to renal function injury in laparoscopic partial nephrectomy (LPN). To evaluate functional outcome， safety and efficacy of zero Ischemia， laparoscopic radiofrequency ablation assisted tumor enucleation (LRATE) in comparison with conventional LPN.

Material & Methods：A prospective randomized controlled trial was conducted from April 2013 to March 2015 in patients with cT1a renal tumor scheduled for laparoscopic nephron sparing surgery. Patients were randomized to LRATE or LPN group. Patients were followed for 12 months. Group LRATE underwent tumor enucleation following radiofrequency ablation for 1 to 4 cycles without renal hilar clamping. Group LPN underwent renal artery clamping. Primary outcome was the change in glomerular filtration rate (GFR) of the affected kidney by renal scintigraphy at 12 months postoperatively. Secondary outcomes included changes of estimated GFR (eGFR)， serum creatinine， GFR of the affected kidney， estimated blood loss， operative time， postoperative complications， hospital stay and oncologic outcomes. The Pearson chi-square or Fisher exact， Student’s t and Wilcoxon rank sum tests were used.

Results：The trial finally enrolled 89 patients， of whom 44 were randomized to LRATE group and 45 to LPN group. One patient in LPN group converted to radical nephrectomy. Compared with Group LPN， group LRATE patients had less decrease in GFR of affected kidney at 3 (10.2% vs 20.4%， P= 0.001) and 12 months (7.6% vs 16.2%，P=0.003). Group LRATE patients had shorter median operative time (P=0.003)， less estimated blood loss (P＜0.001)， shorter hospital stay (P=0.029)， but similar postoperative complications (P=1.000). There were no positive margins and local recurrence in this study. Main limitations are the setting at a single high-volume center， small cohort; we also excluded renal tumors involving urinary collecting system.

Conclusions：Zero ischemia LRATE enables tumor excision with better renal function preservation comparing with conventional LPN. Blood loss， operative time and hospital stay were lower using this technique. Similar postoperative complication rates， oncologic outcomes and surgical margins were observed regardless of surgical technique. We strongly recommend this zero ischemia technique in selected renal tumor patients.