銩激光輔助與傳統腹腔鏡保留腎單位手術治療腎血管平滑肌脂肪瘤臨床療效及安全性比較（“大家泌尿網”觀看手術視頻）

Comparison of efficacy and safety of thulium laser-assisted and laparoscopic nephron-sparing surgery in the treatment of renal angiomyolipoma

HUANG Kai1，2，ZHANG Jingguang1，2 ，CHEN Biao2，SHEN Zhou1.2 （1.Graduate School of Bengbu Medical University，Bengbu 233000；2. Department of Urology，Centre for Leading Medicine and Advanced Technologies of IHM，The First Affiliated Hospital of USTC，Division of Life Sciences and Medicine，University of Science and Technology of China，Hefei 230o0l，China）

ABSTRACT：ObjectiveTo explore the clinical eficacyand safetyof thulium laser-asisted versus traditionallaparoscopic nephron-sparing surgery for the treatmentof exophyticrenal angiomyolipoma（AML），soas toprovidereference for the treatment selectionof this disease.MethodsTheclinical data of 43 AML patients admited toour hospitalduring Jan.2022 andNov.2O24 wereretrospectivelyanalyzed，including1Ocases inthe thulium lasergroupand33casesinthe traditional laparoscopic group.Inthe thulium laser group，renalarteryclamping was notperformed，whilethe traditionallaparoscopic group underwent conventionalrenalarteryclamping.The general and perioperativedata of the two groups were compared. ResultsAll43 patientssucessully underwent surgery，with postoperative pathological confirmation of AMLand no severe complications.Therewerenostatisticallysignificant diferencesbetweenthetwo groupsin termsof operation time， intraoperativebloodloss，hemoglobin declineonthefirstdaypostoperatively，catheterindwellingtime，and postoperative hospital stay. The thulium laser group had shorter warm ischemia time [O min vs. （2 1.88±3.84 ） min ， and less decline in estimated glomerular filtration rate（eGFR） 3 months after operation （5.74 than the traditional laparoscopic group. During a follow-up of 4-34 months，no tumor recurrence was observed. ConclusionThulium laser-asisted laparoscopic nephron-sparing surgery is safeand feasible in the treatment of exophyticrenal AML without renal artery clamping，which may have promising advantages in the protectionof renal function.

KEY WORDS：thulium laser;renal angiomyolipoma;renal artery clamping； nephron-sparing surgery; laparoscope;estimated glomerular filtration rate

中圖分類號：R692.9 文獻標志碼：A DOI：10.3969/j.issn.1009-8291.2025.08.009

腎血管平滑肌脂肪瘤（angiomyolipoma，AML）又稱腎錯構瘤，是一種由血管、平滑肌和脂肪組織組成的腎臟良性腫瘤。研究表明，當腫瘤直徑 gt;4cm 時發生破裂出血的風險顯著上升，可考慮行保留腎單位手術[1-2]。傳統的保留腎單位手術為了減少術中出血、保持視野清晰，術中需阻斷腎動脈，可能導致不同程度的腎臟缺血再灌注損傷，引發暫時或永久性腎功能損害。研究表明，較長的熱缺血時間與術后急性腎衰竭密切相關[3]。因此，盡可能縮短術中熱缺血時間一直是泌尿外科學者們努力探索的方向。

醫用激光因具有良好的切割、凝固和止血特性，近年來開始被嘗試用于治療腎臟小腫瘤，并逐步實現了無阻斷“零缺血\"保留腎單位手術[4-5]。然而，激光切割過程形成的焦痂容易影響術中對惡性腫瘤切緣的判斷，限制了其廣泛應用。良性腫瘤AML對切緣要求相對寬松，激光輔助在本病應用價值更高，而目前國內外相關研究報道較少。中國科學技術大學附屬第一醫院泌尿外科自2022年開始采用銩激光輔助腹腔鏡下保留腎單位手術治療腎AML，術中無需阻斷腎動脈，能有效保護患者腎功能。

1資料與方法

1.1一般資料回顧性分析2022年1月—2024年11月中國科學技術大學附屬第一醫院收治的43例行保留腎單位手術的外生性腎AML患者的病例資料，其中銩激光組10例、傳統腹腔鏡組33例。

納入標準： ① 術前計算機斷層掃描（computedtomography，CT）或磁共振成像（magneticresonanceimaging，MRI診斷為腎AML，4cm≤腫瘤直徑≤7cm 5 ② 非腎門腫瘤且呈外生性；……