际技术上不总是可行的,简单的肿瘤摘除已被提议为一种代替[1]。多数学者主张距肿瘤边缘0.5～1cm切除肿瘤,可有效避免LPN后局部复发,而欧洲泌尿外科学会(EAU)指南中认为只要能完整切除肿瘤,边缘的厚度不影响肿瘤复发率。LPN组8例肾透明细胞癌距肿瘤边缘约1cm处用超声刀行肿瘤切除,肾门小肿瘤切缘距肿瘤约0.5cm,术后病检切缘均阴性。肾癌患者术后随访3～36个月无远处转移,局部复发。LPN与OPN相比临床疗效相似,采用bulldog夹单纯阻断肾动脉和肾实质连续缝合技术,缩短了热缺血时间,且有创伤小、术后恢复快、美观等优点,短期随访安全有效,值得临床推广。参考文献[1]TouijerK,JacqminD,KavoussiLR,etal.Theexpandingroleofpartialnephrectomy:acriticalanalysisofindications,results,andcomplications[J].EurUrol,2010,57(2):214-222.[2]MarszalekM,ChromeckiT,Al-AliBM,etal.Laparoscopicpartialnephrectomy:aMatched-paircomparisonofthetransperitonealver-sustheretroperitonealapproach[J].Urology,2011,77(1):109-113.[3]王德林,蒲军,张尧,等.后腹腔镜bulldog夹阻断肾动脉连续缝合行肾部分切除术24例分析[J].重庆医学,2011,40(33):3346-3347.[4]BeckerF,RoosFC,JanssenM,etal.Short-termfunctionalandon-cologicoutcomesofnephron-sparingsurgeryforrenaltumours≥7cm[J].EurUrol,2011,59(6):931-937.[5]FunahashiY,HattoriR,YamamotoT,etal.Ischemicrenaldamageafternephron-sparingsurgeryinpatientswithnormalcontralateralkidney[J].EurUrol,2009,55(1):209-215.[6]NguyenMM,GillIS.Halvingtheischemiatimeduringlaparoscopicpartialnephrectomy[J].JUrol,2008,179(2):627-632.[7]PouliotF,PantuckA,ImbeaultA,etal.Multivariateanalysisofthefactorsinvolvedinlossofrenaldifferentialfunctionafterlaparo-scopicpartialnephrectomy:aroleforwarmischemiatime[J].CanUrolAssocJ,2011,5(2):89-95.[8]KapoorA.Laparoscopicpartialnephrectomy:achallengingopera-tionwithasteeplearningcurve[J].CanUrolAssocJ,2009,3(2):119.[9]CampbellSC,NovickAC,BelldegrunA,etal.Guidelineforman-agementoftheclinicalT1renalmass[J].JUrol,2009,182(4):1271-1279.收稿日期:修回日期:2012-01-27编辑:孙洪芳帕瑞昔布钠对上腹部手术术后舒芬太尼静脉镇痛效果的影响熊先锋(湖南省张家界市桑植县中医院麻醉科,湖南张家界427100)中图分类号:R614文献标识码:A文章编号:1006-2084(2012)06-0939-03摘要:目的探讨帕瑞昔布钠应用于上腹部手术后舒芬太尼静脉自控镇痛(PCIA)效果的影响。方法选择80例ASAⅠ～Ⅱ级全麻下行上腹部手术患者,分为A组帕瑞昔布钠组,B组生理盐水组。于术毕前半小时A组静脉推注帕瑞昔布钠40mg(用生理盐水稀释成2mL),B组静脉推注生理盐水2mL,术毕即开始进行舒芬太尼PCIA。用视觉模拟评分法(VAS)观察两组患者术后2d内各时点的镇痛效果;同时记录48h舒芬总用量以及需哌替镇痛患者例数;平均自控镇痛(PCA)总按压次数和有效次数;记录患者满意度;两组患者术后不良反应的发生率。结果A组患者术后1、2、4、8、12hVAS评分低于B组;舒芬太尼用量以及PCA总按压次数及有效按压次数A组均少于B组,需哌替镇痛的患者数A组亦少于B组;B组恶心、呕吐发生率高于A组。结论帕瑞昔布钠联合舒芬太尼PCIA用于上腹部手术的术后镇痛安全、有效,值得在临床推广应用。关键词:舒芬太尼;帕瑞昔布钠;术后镇痛EffectsofParecoxibSodiumonSufentanilIntravenousAnalgesiaafterUpperAbdominalOperationXIONGXian-feng.(DepartmentofAnesthesiology,ZhangjiajieCityChineseMedicineHospitalinSangzhiCountyofHunanProvince,Zhangjiajie427100,China)Abstract:ObjectiveTodiscusstheeffectofparecoxibsodiumonsufentanilintravenousanalgesiaafterupperabdominaloperation.Methods80casesofASAⅠ-ⅡabdominaloperationpatientsweredividedintogroupA(parecoxibgroup)andgroupB(salinegroup).Inhalfanhourbeforetheoperation,groupAwasintra-venouslyinjectedparecoxibsodium40mg(dilutedwithsalineinto2mL),groupBwasintra...
